PRIZE     ESSAY. 


PRIZE  ESSAY. 


ON 


THE  CORPUS  LUTEUM 


MENSTRUATION  AND  PREGNANCY. 


y 


BY 


JNO.  C.  [DALTON,  Jr.,  M.  D. 


Extracted  from  the  Transactions  of  the  American  Medical  Association. 


PHILADELPHIA: 
T.   K.   AND   P.   G.   COLLINS,   PRINTERS. 

1851. 


o  r..  X  '  ' 
851 1 


C-L 


ON    THE   CORPUS    LUTEUM 


OF 


MENSTRUATION  AND  PREGNANCY. 


INTRODUCTION. 

There  exists  among  medical  writers  at  the  present  day  a  very 
confused  idea  with  regard  to  the  corpus  luteum.  Notwithstanding 
the  endless  controversies  that  have  been  carried  on  respecting  its 
origin,  growth,  and  structure,  there  is  still  a  great  diversity  of 
opinion  on  all  these  points,  even  among  those  who  have  personally 
devoted  their  attention  to  the  matter ;  and  for  the  general  reader 
it  would  certainly  be  impossible,  from  the  various  accounts  which 
have  been  published,  to  arrive  at  any  satisfactory  conclusion.  These 
contradictory  opinions  prevailed  not  only  in  the  earlier  epochs,  when 
Haller*  denied  positively  that  corpora  lutea  were  ever  to  be  found 
in  virgin  females,  and  when  Meckelf  considered  them  as  glandular 
structures,  destined  to  secrete  a  sort  of  "fluide  generateur,"  or 
female  semen ;  but  even  at  the  present  day,  when  so  much  addi- 
tional light  has  been  thrown  on  the  whole  history  of  generation,  a 
similar  diversity  exists  ;  and  the  corpus  luteum  is  now  described  by 
different  authors  as  a  development  of  the  outer  and  of  the  inner 
membrane  of  the  Graafian  vesicle,  as  a  deposit  between  the  two 
membranes,  and  as  a  growth  external  to  both.  Perhaps  the  most 
debatable  question  of  all  relates  to  its  connection  with  conception 
and  pregnancy.  At  an  earlier  period,  this  was  simply  a  question 
whether  corpora  lutea  ever  existed  in  the  ovaries,  except  as  a  con- 
sequence of  impregnation :  some  writers,  with  Haller,  denying  the 

*   First  Lines  of  Physiology,  Am.  ed.,  1803,  p.  430. 
■j-  Manuel  d'Anatomie,  vol.  jii.  p.  730. 


b  PRIZE    ESSAY. 

possibility  of  such  an  occurrence,  while  others  asserted  that  they 
had  frequently  observed  them  in  virgin  animals  and  unmarried 
women.  In  later  times,  however,  it  became  a  question  of  the  pos- 
sibility of  establishing  a  distinction  between  true  and/a?sg  corpora 
lutea;  i.  e.,  those  which  resulted  from  impregnation,  and  those 
which  owed  their  origin  to  some  other  cause.  Notwithstanding 
these  differences,  however,  it  has  been  always  reducible  to  a  single 
very  interesting  and  important  inquiry,  viz.,  whether,  from  the  ex- 
istence of  a  "  corpus  luteum"  in  the  ovary,  it  can  with  certainty  be 
inferred  that  impregnation  has  taken  place. 

Among  those  who  considered  the  corpus  luteum  as  necessarily 
connected  with  impregnation,  many,  like  Haller  and  Meckel,  had 
no  conception  of  the  spontaneous  discharge  of  ova  during  the 
season  of  heat  in  the  lower  animals,  and  at  the  period  of  menstrua- 
tion in  the  human  female  ;  a  process  which  has  recently  been  more 
or  less  generally  recognized  as  a  regular  and  natural  function. 
Consequently,  they  regarded  the  corpus  luteum  as  only  resulting 
from  sexual  intercourse,  or,  at  least,  from  some  extraordinary  ex- 
citement of  the  generative  system.  William  Hunter,  in  his  plates 
of  the  human  gravid  uterus,  gives  drawings  of  the  corpus  luteum 
as  an  acknowledged  and  indubitable  accompaniment  of  pregnancy 
alone. 

John  Haighton,*  in  a  paper  on  this  subject  in  the  Philosophical 
Transactions,  comes  to  the  following  conclusion:  "I  may  then  say 
that  no  corpora  lutea  exist  in  virgin  animals ;  and  that,  whenever 
they  are  found,  they  furnish  incontestable  proofs  that  impregnation 
either  does  exist,  or  has  preceded."  He  does  not,  therefore,  recog- 
nize any  distinction  between  corpora  lutea,  nor  the  possibility  of 
any  discharge  of  ova  independent  of  sexual  intercourse.  He  uncon- 
sciously, however,  himself  furnishes  evidence  that  such  discharge 
may  take  place,  in  his  various  experiments  in  which  the  oviducts 
were  divided  before  and  after  coition ;  corpora  lutea  being  found  in 
the  ovaries  in  both  instances.  "We  should  expect,''  he  says,  "  in 
the  one  case  to  find  the  full  effects  of  impregnation,  and  in  the  other 
no  traces  of  it  would  be  seen.  Instead  of  which,  the  procreative 
actions  (formation  of  corpora  lutea)  are  no  further  advanced  where 
there  has  been  an  opportunity  for  the  passage  of  the  semen,  than  in 
those  cases  where  its  passage  has  been  impossible."  He  attempts 
to  explain  this  apparent  contradiction  by  supposing  that  the  ovary 

»  Phil.  Trans.,  1797,  p.  114 


INTRODUCTION.  7 

is  excited  to  the  expulsion  of  the  ovum  by  "  consent  of  parts;"  the 
stimuhis  of  the  seminal  fluid  in  the  uterus  being  sufficient  to  cause 
the  rupture  of  a  Graafian  vesicle,  although  its  passage  to  the  ovary- 
has  been  interrupted.  It  apparently  does  not  occur  to  him  that  the 
assumed  connection  betvreen  the  corpus  liiteum  and  a  preceding 
coition  is  entirely  without  proof;  and  that,  without  this  assumption, 
there  would  have  been  no  discrepancy  in  the  appearances  which  he 
is  at  so  much  pains  to  reconcile. 

Cruikshank*  also  relates  an  instance,  in  the  human  subject,  in 
which  the  rupture  of  a  Graafian  vesicle  was  not  improbably  quite 
independent  of  coitus,  without  in  the  least  suspecting  the  true 
nature  of  the  case.  "  I  also  have,"  he  says,  "in  my  possession  the 
uterus  and  ovaries  of  a  young  woman  who  died  with  the  menses 
upon  her;  the  external  membranes  of  the  ovaria  are  burst  at  one 
place ;  whence,  I  suspect,  an  ovum  escaped,  descended  through  the 
tubes  to  the  uterus,  and  was  washed  ofi"  by  the  menstrual  blood." 
The  writer,  however,  as  may  be  gathered  from  the  context,  evidently 
supposes  that  the  escape  of  this  ovum  was  in  consequence  of  coitus ; 
since,  throughout  his  paper,  he  considers  the  occurrence  of  a  corpus 
luteum  as  direct  proof  of  impregnation. 

Velpeauf  speaks  of  the  corpus  luteum  as  a  growth  taking  place 
"after  coition,"  without  alluding  to  the  possibility  of  its  formation 
under  any  other  circumstances. 

Montgomery!  takes  much  the  same  view  of  the  matter.  He 
speaks  of  the  maturation  and  discharge  of  an  ovum,  and  the  accom- 
panying growth  of  a  corpus  luteum  as  taking  place  "on  the  occur- 
rence of  conception;"  and,  though  he  acknowledges  that  bodies 
resembling  corpora  lutea  may  be  produced  in  the  ovary  by  other 
causes,  yet  the  true  corpus  luteum,  resulting  from  impregnation,  may, 
according  to  him,  be  always  distinguished  from  them.  "Such,"  he 
says  (p.  240),  "is  the  result  of  my  own  observations  on  a  very  large 
number  of  bodies,  both  of  women  and  animals ;  and  in  no  one  in- 
stance did  I  ever  find  a  true  corpus  luteum,  except  as  the  product 
of  conception."  He  gives  some  marks  by  which  the  true  corpora 
lutea  are  to  be  distinguished  from  the  false,  but  his  description,  in 
this  respect,  must  be  regarded  as  somewhat  imperfect.  The  yellow 
matter  of  the  corpus  luteum  he  considers  to  be  surrounded  by  the 
outer  membrane  of  the  Graafian  vesicle,  while  its  cavity  is  lined  by 
the  inner,  it  being  enclosed  between  the  two. 

•  Phil.  Trans.,  1797,  p.  135.  f  Treatise  on  Midwifery,  Meigs"  ed.,  Philad.,  1831. 

J  W.  F.  Montgomery,  Signs  and  Symptoms  of  Pregnancy,  London  1837. 


8  PRIZE    ESSAY. 

Dr.  Gross*  recognizes  the  occasional  existence  of  false  corpora 
lutea,  which,  he  says,  may  be  produced  without  coitus,  in  conse- 
quence of  "strong  sexual  excitement."  He  concludes,  however, 
principally  following  in  the  track  of  Montgomery,  that  the  true  cor- 
pus luteum  is  good  evidence  of  pregnancy. 

Dr.  Edward  J.  Seymour,!  though  he  acknowledges  that  corpora 
lutea  occasionally  exist  without  impregnation,  inclines  to  the  opinion 
that,  as  a  general  rule,  they  are  good  evidence  of  its  having  taken 
place.  "From  these  premises,  comparisons,  and  observations,"  he 
says  (p.  32),  "my  opinion  has  been  formed  that  corpora  lutea  are 
the  result  of  the  change  which  takes  place  in  the  ovarium  by  the 
bursting  and  discharge  of  the  ovum — occurring  rarely  in  virgin  ani- 
mals, because  the  bursting  of  an  ovum  is  not  a  frequent  but  only 
a  possible  occurrence,  but  always  following  impregnation,  and  dimin- 
ishing as  gestation  proceeds." 

Dr.  Blundell|  expresses  himself  on  this  point  with  great  reserve. 
He  thinks  that,  in  some  of  the  lower  animals,  a  corpus  luteum,  "  not 
to  be  distinguished  from  that  of  impregnation,"  may  be  produced 
without  sexual  intercourse,  and  merely  by  great  nervous  excitement; 
and  he  is  not  prepared  peremptorily  to  decide  the  question  even  with 
regard  to  the  human  female  ;  but  considers,  nevertheless,  a  "  fabi- 
form  corpus  luteum,  with  an .  asteriskal  cavity,"  &c.  &c.,  as  strong 
presumptive  proof  of  impregnation. 

J.  Miiller§  regards  the  discharge  of  ova  as  a  consequence  of  sex- 
ual intercourse,  and  must  therefore  hold  the  same  opinion  with  re- 
gard to  corpora  lutea.  "  In  mammalia,"  he  says,  "the  separation 
of  the  ovum  from  the  ovary  seems  to  be  dependent  on  the  act  of  im- 
pregnation. It  has,  it  is  true,  been  stated  that  cicatrices  of  the  ova- 
ries, resulting  from  the  escape  of  ova,  have  been  seen  in  the  bodies 
of  virgins  ;  but  this  is  certainly  no  ordinary  occurrence." 

Dr.  Carpenterjl  adopts  principally  Montgomery's  description  of 
the  corpus  luteum,  and  his  opinion  that  it  is  a  good  sign  of  impreg- 
nation. He  has,  however,  no  original  observations  on  the  subject. 
He  also  regards  as  "  not  improbable,"  the  theory  that  ova  are  ma- 
tured and  discharged,  at  each  menstrual  period,  independently  of 
fecundation  ;  though  he  thinks,  with  Dr.  Barry,  that  it  is  more  likely 

*  S.  D.  Gross,  Elements  of  Pathological  Anatomy,  Philad.  1845. 

■j"  Illustrations  of  some  of  the  Diseases  of  the  Ovaria,  London  1830. 

J  On  Diseases  of  Woman,  Philad.  ed.  1840. 

§  Miillers  Physiology,  Philad.  ed.  1843. 

II   Principles  of  Human  Physiology,  Philad.  ed.  1843. 


INTRODUCTION".  9 

that  the  matured  ova  retrograde  and  become  absorbed,  without  hav- 
ing been  discharged. 

Dr.  Robert  Lee*  admits  a  distinction  between  true  and  false  cor- 
pora lutea,  or  those  connected  with  impregnation  and  those  arising 
from  other  causes.  His  ideas,  liowever,  regarding  the  precise  pro- 
cess which  takes  place  in  menstruation  do  not  seem  to  be  very  clear- 
ly announced;  for,  although  he  considers  it  probable  that  about 
the  menstrual  period  there  is  a  rupture  of  the  Graafian  vesicle,  he 
nevertheless  denies  that  an  ovum  is  discharged  at  this  time.  "That 
an  ovum,"  he  says,  "  does  not  pass  from  the  ovarium  during  men- 
struation is  evident  from  the  fact  that  an  ovum  is  never  found  but 
as  a  consequence  of  impregnation,  and  that  conception  does  not  take 
place  during  the  menstrual  period. "f  He  describes  the  yellow  mat- 
ter of  the  corpus  luteum  as  situated  externally  to  both  layers  of  the 
Graafian  vesicle,  without  anything  interposed  between  it  and  the 
ovarian  tissue. 

Dr.  Robert  Paterson  has  two  papers  on  this  subject  in  the  Edin- 
hurgh  Medical  and  Surgical  Journal,  in  the  first  of  which  (January, 
1840)  he  gives  a  somewhat  extended  notice  of  the  distinguishing 
marks  of  "true  corpora  lutea,"  i.  <?.,  those  consequent  on  impregna- 
tion ;  and  he  concludes  that  the  corpus  luteum,  provided  certain  ap- 
pearances exist,  is  "undeniable  proof  that  the  individual  has  been 
pregnant."  Dr.  Paterson  describes  the  true  corpus  luteum  as  de- 
posited between  the  layers  of  the  Graafian  vesicle.  The  false  he 
considers  as  arising  principally  either  from  (1st)  a  more  or  less  com- 
plete filling  of  a  Graafian  vesicle  with  blood  independently  of  im- 
pregnation, or  (2d)  undefined  effusions  of  blood  into  the  substance  of 
the  ovary  ;  a  true  apoplexy  of  the  organ.  They  may,  moreover, 
arise  from  re-absorption  and  puckering  of  a  vesicle,  or  from  various 
morbid  deposits.  He  recognizes  the  spontaneous  discharge  of  ova 
only  to  a  limited  extent.  "  The  period  of  menstruation,"  he  says, 
"is  marked  by  the  prominence  of  one  or  more  of  the  Graafian 
vesicles,  and  by  their  occasional  rupture."  A  more  common  oc- 
currence, however,  he  thinks  to  be  "  simple  enlargement  of  a  vesicle, 
the  increased  quantity  of  fluid  in  which  becomes  afterwards  reab- 
sorbed." Dr.  P.'s  communications  are  accompanied  by  a  number  of 
observations  and  coloured  drawings,  illustrative  of  the  difference  be- 
tween true  and  false  corpora  lutea.     These,  however,  do  not  seem  to 

•  Lectures  on  Midwifery,  London  Med.  Gazelle,  1842. 
t  Cyclop.  Pract.  Med.  iii.  444. 


10  PRIZE    ESSAY. 

be  quite  perfect,  as  some  of  his  cases,  related  under  the  head  of 
"true  corpora  lutea,"  are  entirely  deficient  in  evidence  of  impregna- 
tion, and  in  some  of  his  drawings  he  designates  as  mere  "  puckered 
cysts,"  &c.,  what  are  evidently  corpora  lutea  of  menstruation,  in  a 
retrograde  state. 

Dr.  Frank  Renaud,  of  Edinburgh,  has  a  highly  interesting  and 
valuable  paper  on  this  subject  in  the  London  and  Edinburgh  Monthly 
Journal  of  Medical  Science  for  August,  1845.  The  plan  of  the 
memoir  is  somewhat  similar  to  that  of  Dr.  Paterson's,  and  it  gives 
by  far  the  clearest  and  most  accurate  account  of  true  and  false  cor- 
pora lutea  that  I  have  anywhere  been  able  to  meet  with.  Dr.  R. 
takes  much  the  same  view  with  Dr.  Paterson  of  the  processes  con- 
nected with  menstruation,  viz.,  that  "towards  each  menstrual  period 
the  Graafian  vesicles  become  developed,"  and  "sometimes  burst." 
He  does  not,  however,  consider  this  as  a  regular  and  natural  occur- 
rence ;  nor  does  he  describe  the  false  corpora  lutea  as  always  con- 
nected with  menstruation. 

It  will  be  observed  that  a  certain  proportion  of  the  above  writers 
speak  of  the  corpus  luteum  as  a  sign  of  pregnancy,  without  mention- 
ing its  particular  marks  or  distinctive  characters  ;  Avhile  those  who 
have  given  a  more  detailed  description  of  it  mention  also  certain 
other  bodies,  false  corpora  lutea,  which  they  consider  as  occasional 
morbid  or  extraordinary  growths,  varying  in  their  nature,  and  acci- 
dental in  their  formation. 

On  the  other  hand,  are  a  crowd  of  observers,  who,  in  the  earlier 
times,  met  with  "  corpora  lutea"  in  virgin  women  or  in  virgin  ani- 
mals. Malpighi,  Valisnieri,  Santorini,  Brugnone,  Bertrandi,  are 
all  cited  by  later  writers  as  having  borne  testimony  to  this  fact. 
Neither  have  others  been  Avanting,  in  modern  times,  to  sustain  a  simi- 
lar view. 

Dr.  John  Burns,*  indeed,  expresses  himself  somewhat  doubtfully 
in  regard  to  it.  "  It  has  been  conjectured  by  some,"  he  says,  "  that 
the  corpus  luteum  may  be  produced  even  without  sexual  intercourse ; 
but  this  point  I  cannot  determine.''  He  does  not,  however,  speak 
of  the  corpus  luteum  as  positively  existing  in  company  with  any 
other  uterine  production  than  a  foetus  or  hydatids.  "  The  appear- 
ances during  life,  or  after  death,  which  occur  from  a  miscarriage, 
may  also  arise  from  the  expulsion  of  hydatids  ;"  in  which  case 
"even  a  distinct  corpus  luteum  may  be  discovered."     Dr.  Burns 

•  Midwifery  and  Diseases  of  Women,  James'  ed.  1813. 


INTRODUCTION.  11 

does  not  here  make  any  distinction  between  those  hydatids  '\^■hich 
evidently  result  from  a  degeneration  of  the  ovum,  and  those  which 
are  supposed  to  constitute  a  true  morbid  production  of  the  uterus ; 
he  appears,  hoAvcver,  to  consider  them  all  as  belonging  to  the  former 
class. 

Sir  Everard  Home,  in  his  two  papers  on  corpora  lutea  in  the  Phi- 
losopliical  Transactions,*  denies  that  there  is  any  difference  between 
the  corpora  lutea  resulting  from  impregnation,  and  those  which  are 
produced  independently  of  any  such  influence.  He  gives  a  very 
confused  and  unsatisfactory  account  of  some  observations  which  he 
adduces  "  in  proof"  that  corpora  lutea  are  not  bodies  formed  in  con- 
sequence of  the  discharge  of  ova,  but  are  the  glandular  structures 
in  which  the  ova  are  produced  ;  that  they  are  "  formed  previous  to 
and  independent  of  sexual  intercourse ;  and  that,  when  they  have 
fulfilled  their  purpose  of  forming  ova,  they  are  afterward  removed 
by  absorption,  whether  the  ova  are  impregnated  or  not."  He  even 
goes  so  far  as  to  say  that  physiologists  have  been  led  into  the  error 
of  "  mistaking  a  corpus  luteum  in  which  an  ovum  is  forming  for 
that  which  belonged  to  the  ovum  of  the  present  conception,  and 
which,  at  the  time  of  delivery,  has  disappeared;"  and  that  it  will 
be  found  that  "  all  the  preparations  of  corpora  lutea,  from  the  ovaria 
of  women  who  die  in  childbed,  actually  belong  to  this  new  ovum, 
not  yet  completely  formed."  It  is  impossible,  however,  to  discover 
in  either  of  the  papers  anything  like  "  proofs"  of  these  extraordi- 
nary assertions  ;  unless,  indeed,  a  drawing  may  be  considered  as 
such  Avhich  he  gives  of  a  corpus  luteum,  imbedded  in  the  substance 
of  an  ovary,  and  containing  a  very  dubious-looking  body,  which  the 
writer  calls  an  ovum,  but  which  is  entirely  unlike  the  ova,  as  seen 
by  other  observers,  while  yet  contained  within  the  ovary.  The 
accuracy  of  his  logical  inferences  may  be  estimated  from  the  fact 
that  he  regards  the  presence  of  a  hymen  as  proof  positive  of  vir- 
ginity. 

Sir  Everard  Home  admits  that  ova  do  pass  from  the  ovaries  ante- 
riorly to  impregnation,  but  does  not  seem  to  think  this  an  occurrence 
which  takes  place  in  the  human  female  at  any  regular  period.  He 
denies  explicitly  that  it  has  any  connection  with  menstruation ;  for, 
after  relating  the  case  of  a  girl  who  died  seven  days  after  an  ex- 
pected menstrual  period,  and  in  whom  the  ovary  was  found  to  con- 
tain two  "corpora  lutea,"  and  the  uterus  an  ovum  of  minute  size, 

•  Pl.il.  Trans.  1817  and  1S19. 


12  PRIZE    ESSAY. 

he  says,  "It  is  clear,  from  the  case  which  has  just  been  stated,  that 
such  (menstrual)  periods  are  totally  unconnected  with  the  formation 
of  the  ovum,  the  process  of  its  leaving  the  ovary,  or  its  impregna- 
tion." 

Dr.  Dewees*  adopts,  without  discussion.  Sir  Everard  Home's  view 
of  the  matter. 

Dr.  Gooch,t  though  he  at  first  speaks  of  the  corpus  luteum  as 
formed  from  the  rupture  of  a  Graafian  vesicle  "after  conception," 
does  not  allow  that  the  two  are  necessarily  connected  as  cause  and 
effect.  "Some  persons,"  he  says  (p.  87),  "will  pretend  to  say, 
from  an  inspection  of  the  ovary,  how  many  conceptions  have  taken 
place,  but  corpora  lutea  have  been  seen  in  virgins."  This  state- 
ment, however,  is  entirely  unaccompanied  by  proofs,  or  by  any  de- 
tailed description  of  the  bodies  in  question. 

Boivin  and  Duges,  in  their  treatise  on  Maladies  of  the  Uterus,| 
give  no  very  clear  description  of  corpora  lutea,  nor  any  decisive 
opinion  as  to  their  nature.  It  is  merely  stated  that  they  have  often 
been  found  in  "  unmarried"  females.  In  the  atlas,  there  is  one 
figure  of  an  ovary,  showing  the  external  cicatrix  of  a  corpus  luteum, 
but  no  internal  view. 

T.  Wharton  Jones§  recognizes  the  periodical  discharge  of  ova 
from  the  ovary,  but  does  not  consider  this  occurrence  as  ordinarily 
resulting  in  the  formation  of  a  corpus  luteum.  He  ingeniously 
accounts  for  the  supposed  fact  that  every  such  discharge  is  "  not 
followed  by  a  corpus  luteum,''  as  follows: — 

I.  The  regular  and  periodical  discharge  of  ova  takes  place  with- 
out increased  action,  and  consequently  leaves  little  or  no  trace. 

II.  Coitus  hurries  the  maturation  and  discharge  of  ova  by  in- 
flammation and  exudation,  which  result  afterwards  in  the  corpus 
luteum. 

III.  When  coitus  coincides  with  the  regular  maturation  of  a 
Graafian  vesicle,  no  corpus  luteum  is  formed. 

He  acknowledges,  however,  that  this  is  "physiological  specula- 
tion," and  says  that,  practically,  "it  would  be  rash  and  unwarrantable 
for  any  one  to  pronounce,  from  the  occurrence  of  a  corpus  luteum 
in  the  ovaries,  that  coitus  had  taken  place." 

•   System  of  Midwifery.  Pliilad.  1826.  V 

t  Gooch's  Midwifery,  Pliilad.  ed.  1832.  ™ 

J  Heming's  Translation,  London,  1834. 
§  London  Medical  Gazette,  vol.  xxxiv.  p.  625, 


INTRODUCTION.  13 

Dr.  Robert  Knox*  also  tliinks  that  ova  "may  often"  be  discharged 
from  virgin  ovaries,  corpora  lutea  being  formed  in  consequence ;  but 
he  does  not  look  upon  this  as  an  established  fact.  Though  he  insti- 
tutes some  comparisons  between  the  true  and  false  corpus  luteum, 
the  distinctions  which  he  lays  down  are  very  imperfect,  relating 
chiefly  or  entirely  to  the  comparative  size  of  the  bodies ;  and  from 
his  observations  and  details  he  finally  draws  the  following  conclu- 
sion, viz.,  that  "there  is  no  distinctive  character  by  which  the 
corpus  luteum  (of  impregnation)  may  be  distinguished  from  the 
miniature  (or  false)  corpus  luteum." 

The  above  details  will  serve  to  show  how  various  are  the  opinions, 
and  how  contradictory  the  statements,  which  have  been  brought  for- 
ward by  medical  writers  on  this  subject.  When,  however,  it  be- 
came more  perfectly  established,  from  the  recent  researches  of  phy- 
siologists, that  a  regular  and  periodical  maturation  and  discharge  of 
ova  take  place,  not  only  in  the  oviparous  animals,  but  also  in  all 
classes  of  mammalia,  entirely  independent  of  fecundation,  and  even 
of  coition,  an  additional  and  almost  decisive  argument  seemed  to  be 
afforded  to  the  opinion  of  those  who  denied  that  any  peculiar 
appearances  were  produced  in  the  ovary  after  fecundation  which 
could  be  regarded  as  evidence  of  that  occurrence  having  taken 
place.  For,  if  the  ovum  is  matured  and  expelled  from  the  ovary 
independently  of  any  external  influence,  and  is  only  fecundated  at 
the  time  of  its  expulsion,  or  during  its  passage  through  the  oviduct, 
how  could  this  later  and  accidental  occurrence  have  any  influence 
on  the  ulterior  changes  in  the  ruptured  Graafian  vesicle — changes 
with  which  it  had  no  necessary  or  physiological  connection  ?  It  re- 
sulted, as  was  said,  not  only  from  analogical  inferences,  but  also 
from  the  observation  of  nature,  that  the  corpus  luteum  is  formed  in 
the  ovary,  after  the  discharge  of  the  ovum,  in  the  same  regular  and 
uninterrupted  manner,  whether  that  ovum  becomes  subsequently 
fecundated  by  the  spermatic  fluid,  or  Avhether,  as  more  frequently 
happens,  it  rapidly  loses  its  vitality,  and  is  destroyed.  Such  an 
apparently  superfluous  production  of  ova,  destined  to  perish  with- 
out ever  receiving  impregnation,  was  not  without  abundant  analogy 
among  the  lower  orders  of  organized  beings.  It  had  been  long 
known  that  the  spawn  of  fishes  wxre  expelled  by  the  female,  inde- 
pendently of  any  direct  influence  from  the  male  ;  and  that  their 
subsequent  fecundation    depended  entirely  on   the    occurrence   of 

•  London  Medical  Gazette,  vol.  xxxiii.  p.  370. 


14  PRIZE    ESSAY. 

fortuitous  circumstances.  In  the  vegetable  world,  the  dioecious 
plants  presented  the  same  phenomenon ;  many  thousand  germs 
being  annually  produced  by  the  female  individual,  of  which  only  a 
small  proportion  were  destined  ever  to  receive  the  fructifying  influ- 
ence of  the  pollen. 

Bischofif*  was  among  the  first  who  announced  this  theory  in  a  de- 
cisive manner.  He  was  first  led  to  a  knowledge  of  the  fact  by  some 
appearances  which  he  met  with  in  an  experiment  on  animals  in  June, 
1843,  and  communicated  his  discovery  in  a  letter  to  the  French 
i^cademy  on  the  17th  of  July  following.  He  afterwards  brought 
the  matter  before  the  public  in  a  more  extended  form.  In  this  work, 
Bischoff  shows  by  actual  observation  that  the  Graafian  vesicles  be- 
come ruptured  without  coition,  and  in  the  lower  animals  that  the  ova 
enter  the  oviduct,  and  proceed  toward  the  uterus.  "Now  from  all 
these  observations,"  he  says  (p.  45),  "it  is  quite  certain  that  the 
ova  in  mammalia,  in  the  time  of  heat,  no  coition  taking  place,  are 
detached  from  the  ovary,  enter  the  tube,  and  perish  there  ;  and  that 
corpora  lutea  are  formed  in  the  ovaries  just  as  tJiough  coition  and 
fecundation  had  taken  place.'' 

M.  Ndgrierf  has  also  published  a  work  in  which  he  advances  some- 
what similar  opinions.  His  book,  however,  is  written  for  the  par- 
ticular purpose  of  demonstrating  the  dependence  of  the  menstrual 
function  on  certain  periodical  changes  which  take  place  in  the  ovary; 
i.  e.,  the  successive  maturation  and  rupture  of  Graafian  vesicles.  The 
spontaneous  discharge  of  ova  about  the  menstrual  period  is  also 
alluded  to  by  the  author,  but  is  not  asserted  in  so  distinct  and  posi- 
tive a  manner  as  the  former  proposition.  N^grier  does  not,  how- 
ever, consider  the  yellow  bodies  as  always  produced  by  the  rupture 
of  Graafian  vesicles,  but  supposes  the  yellow  matter  to  be  deposited 
between  the  coats  of  the  vesicle  at  a  stage  of  its  development  prior 
to  its  distension  with  fluid  and  final  bursting ;  the  yellow  matter, 
together  with  the  efi"used  blood,  becoming  afterward  rapidly  absorbed. 
In  this  respect,  he  adopts  the  views  of  Sir  Everard  Home,  and,  like 
him,  distinguishes  two  varieties  of  corpora  lutea,  viz.,  the  ascending 
and  the  retrograde ;  or  those  which  are  still  entire,  and  in  process 
of  development,  and  those  which  have  already  become  ruptured. 

*  On  the  Maturation  and  Discharge  of  Ova,  independent  of  Coition ;  Oilman's  and 
Tellkampfs  Translation,  N.  Y.  1847. 

t  Recherches  Anatomiques  et  Physiologiques  sur  les  Ovaires  dans  TEspece  Humaine. 
Paris,  1840. 


INTRODUCTION.  15 

He  imagines,  also,  with  Home,  tlie  yellow  matter  to  be  a  source  of 
nutrition,  or  "  a  kind  of  placenta"  for  the  germ. 

Negrier  recognizes  three  principal  stages  of  the  development  of 
the  Graafian  vesicles  {travail  vSsiculaire). 

I.  The  formation  of  simple,  small,  globular  vesicles,  filled  with 
serosity  [vesicides  primaires). 

II.  A  deposit  of  gray  matter  between  the  walls,  accompanied  by 
a  folding  up  of  the  vesicular  parietes,  and  absorption  of  the  contained 
fluid  {bourses  grises). 

III.  Enlargement  of  the  whole  vesicle,  alteration  of  the  colour 
from  gray  to  yellow  {vesieules  jaunes,  or  corpora  lutea  of  other  writ- 
ers), renewed  secretion  of  serosity,  distension  and  rupture  of  the  vesi- 
cle. Respecting  the  connection  of  corpora  lutea  with  impregnation, 
his  opinions  are  the  same  as  those  of  Bischoff.  "  I  cannot,  however," 
he  says  (Avant-propos,  p.  xv.),  "  share  the  opinion  of  Dr.  Paterson, 
when  he  makes  a  distinction  between  the  vesicular  cicatrices,  of  true 
and  false.  They  are  all  essentially  cicatrices,  consequent  on  the 
rupture  of  a  perfectly  developed  vesicle,  whether  or  not  there  has 
been  any  fecundation  of  the  ovum  which  escaped  from  it ;  and,  if  the 
remains  of  these  organs  do  not  always  bear  a  perfect  resemblance 
to  each  other,  it  is  because  the  rupture  of  the  vesicle  does  not  always 
take  place  in  exactly  the  same  manner ;  because  the  blood,  effused 
from  the  open  vessels,  is  variable  in  quantity ;  and  because  the 
delicate  membranes  of  the  vesicle  are  sometimes  more  extensively 
lacerated,  the  yellow  matter  being,  in  consequence,  more  readily 
dissolved  by  the  extravasated  blood,  and  disappearing  as  the  clot 
becomes  absorbed." 

This  account,  by  Negrier,  of  the  development  of  the  Graafian 
vesicle  and  formation  of  the  corpus  luteum  is  somewhat  complicated, 
and  is,  moreover,  entirely  opposed  to  the  views  entertained  by  most 
other  writers,  as  well  as  to  those  which  will  be  advanced  in  the  pre- 
sent memoir.  M.  Raciborski,*  in  his  work  on  Spontaneous  Ovula. 
tion,  or  the  "  ponte  p6'iodique  spontan<5e,"  adopts  the  more  simple, 
as  well  as  more  probable  theory  that  the  corpus  luteum  is  a  forma- 
tion which  takes  place  altogether  subsequently  to  the  rupture  of  the 
vesicle.  That  part  of  his  work  which  relates  to  ovulation  is  intended 
to  establish  the  fact  of  the  independent  discharge  of  ova,  and  its  con- 
nection, in  the  human  female,  with  menstruation.  His  views,  also, 
lead  him  to  deny  the  existence  of  any  distinguishing  peculiarity  in 

•  M.  A.  Raciborski,  de  la  Puberte  and  de  TAge  critique,  Paris,  1S44. 


16  PRIZE    ESSAY. 

the  corpus  lutcum  of  impregnation.  "  Some  authors,''  he  says  (p. 
511),  "  have  attempted  to  show  a  distinction  of  true  and  false  cor- 
pora lutea ;  the  first  of  which,  according  to  them,  are  met  with  only 
after  a  preceding  conception.  Notwithstanding  all  the  efforts  which 
have  been  made  to  establish  this  distinction,  we  are  far  from  being 
prepared  to  acknowledge  it.  Numerous  observations  upon  animals 
have  convinced  us  that,  whether  the  rupture  of  the  follicles  is,  or  is 
not,  accompanied  by  coitus,  or  by  fecundation,  the  appearance  of  the 
lesions  which  result  is,  in  both  cases,  absolutely  identical." 

But  the  writer  who  has  treated  this  subject  in  the  most  brilliant, 
decisive,  and  convincing  manner  is,  beyond  all  others,  M.  Pouchet. 
His  views  were  first  advanced  in  a  memoir  published  at  Paris,  in 
1842,  entitled  "  Theorie  Positive  de  la  Fdcondation."  It  appeared 
again,  five  years  later,  considerably  amplified,  and  accompanied  with 
elegant  illustrations,  under  the  folloAving  title :  "  F.  A.  Pouchet, 
Theorie  positive  de  I'ovulation  spontande,  et  de  la  fecondation  des 
mammiferes  et  de  I'espece  humaine :  Paris,  1847;"  a  work  which 
for  comprehensiveness  of  design,  brilliancy  of  style,  and  energy  and 
conclusiveness  of  argumentation,  has  been  rarely  equalled  among 
the  productions  of  medical  literature.  In  this  work,  M.  Pouchet 
supports  his  views  by  the  unconscious  testimony  of  a  multitude  of 
earlier  writers  ;  by  many  observations  made  by  himself  both  on  the 
human  subject  and  on  the  lower  animals  ;  and  by  the  analogies  of 
function  between  various  classes  of  animals,  already  known  to  exist, 
or  for  the  first  time  demonstrated  by  himself.  He  establishes,  in 
the  course  of  his  book,  the  following  principal  propositions : — 

I.  That  in  all  classes  of  mammalia  ova  are  produced  spontaneously 
in  the  ovaries. 

II.  That  they  are  expelled  spontaneously  at  regular  intervals,  in- 
dependently of  coition. 

III.  That  in  the  human  female  they  are  so  expelled  at  each  men- 
strual period ;  this  period  corresponding  to  the  rutting  season  of 
animals. 

IV.  That  the  ova  are,  and  can  be,  fecundated  only  after  their 
expulsion  from  the  ovary ;  the  various  solid  membranes,  by  wdiich 
they  are  protected  previous  to  this  expulsion,  opposing  a  complete 
obstacle  to  the  access  of  the  spermatic  corpuscles,  the  actual  con- 
tact of  which  is  indispensable  to  the  impregnation  of  the  ovum. 

V.  That  in  all  probability  the  part  where  fecundation  usually 
takes  place  is  the  cavity  of  the  uterus  or  the  lower  part  of  the 
Fallopian  tube. 


INTRODUCTION.  17 

The  fact  announced  in  the  fourtli  proposition,  viz.,  that  ova  can 
be  fecundated  only  after  leaving  the  ovary,  he  considers  as  evident, 
not  only  from  the  interposition  of  the  ovarian  integuments  between 
the  ova  and  the  spermatozoa,  but  also  from  the  circumstance  that 
contact  with  the  seminal  fluid  does  not  produce  the  effect  of  impreg- 
nation on  immature  ova,  but  only  on  such  as  have  arrived  at  a  cer- 
tain degree  of  development ;  and  that  this  maturity  and  complete 
development  of  the  unimpregnated  ovum  correspond  in  time  pre- 
cisely with  its  discharge  from  the  Graafian  vesicle. 

The  proofs  of  the  third  proposition,  that  the  discharge  of  ova 
takes  place  in  women  at  the  menstrual  period,  are,  with  him,  almost 
entirely  drawn  from  analogy  ;  as  he  gives  but  few  direct  observa- 
tions on  the  human  female  bearing  on  the  connection  between  ovu- 
lation and  menstruation.  These  observations  consist  only  of  some 
microscopic  observations  on  the  menstrual  fluid,  which  he  shows  to 
be  entirely  analogous  to  that  discharged  by  mammalia  during  the 
season  of  heat.  Strict  analogical  inferences,  however,  may  he  in 
some  cases  as  reliable  as  direct  observation;  and,  as  the  writer  him- 
self expresses  it,  "The  difficulties  which  oppose  themselves  to  obser- 
vations on  this  subject,  with  regard  to  the  human  female,  compel  us 
here  to  rely  upon  analogy ;  but  in  this  instance,  the  analogy  is  so 
evident  that  it  is  impossible  not  to  acknowledge  it." 

M.  Pouchet's  views,  however,  regarding  the  corpus  luteum  are 
the  same  with  those  of  Bischoff  and  Raciborski.  "At  the  time," 
he  says  (p.  185),  "  that  physiologists,  influenced  by  entirely  theo- 
retical views,  believed  that  ova  were  expelled  only  after  fecundation, 
since  corpora  lutea  were  occasionally  discovered  either  in  women  or 
in  animals  where  no  reproduction  had  taken  place,  some  naturalists 
pretended  that,  in  these  cases,  there  had  been  no  emission  of  ova, 
and  that  the  corpora  lutea  in  question  were  difi"erent  from  those 
which  owed  their  origin  to  ova  capable  of  impregnation.  At  the 
present  day,  this  distinction,  which  never  was  anything  more  than  a 
scholastic  subtlety,  can  no  longer  have  an  existence.'' 

"  Since,  by  these  labors,  the  fact  of  spontaneous  ovulation  has 
been  demonstrated,  it  must  now  be  superfluous  to  point  out  the  futi- 
lity of  the  distinction  between  true  and  false  corpora  lutea  ;  they 
are  all  produced  by  the  same  processes ;  they  have  all  discharged 
ova  before  presenting  themselves  under  the  aspect  which  they  assume 
after  that  occurrence.  And  whether  the  ovule  which  they  have  ex- 
pelled docs  or  docs  not  become  fecundated,  whether  or  not  it  under- 


18  PRIZE    ESSAY. 

goes  the  transformation  into  an  embryo,  all  have,  nevertheless,  the 
same  form  and  the  same  structure.'' 

It  is  the  object  of  the  present  paper  to  shoio  that  this  conclusion 
of  31.  Pouchet  is  entirely  erroneous ;  that  the  corpus  luteum  of 
pregnancy  is  different  from  the  corpus  luteum  of  menstruation ; 
and  that  it  may,  under  ordinary  circumstances,  he  readily  recognized 
and  distinguished  from  it. 

In  the  following  pages,  however,  I  shall  regard  the  five  principal 
propositions  of  M.  Pouchet  as  definitely  established  by  the  observa- 
tions and  arguments  contained  in  his  treatise ;  for  probably  nothing 
which  could  be  here  brought  forward  would  add  any  very  material 
weight  to  the  evidences  there  presented. 

Nevertheless,  the  reader  will  undoubtedly  discover,  among  the 
following  observations,  many  collateral  proofs  of  the  theory  of 
spontaneous  ovulation,  to  which  it  will  not  be  necessary  to  direct 
his  attention  particularly. 

It  will  readily  be  comprehended  that  the  difference  hereafter  to 
be  established  between  the  corpus  luteum  of  menstruation  and  that 
of  pregnancy  is  not  an  essential  or  fundamental  difference.  Since 
the  regular  and  periodical  rupture  of  the  Graafian  vesicle  and  dis- 
charge of  ova,  at  the  time  of  menstruation,  are  here  recognized,  as 
well  as  the  fact  that  corpora  lutea  are  always  formed  in  the  ovaries 
as  a  consequence  of  such  rupture  and  discharge,  the  differences 
alluded  to  must  necessarily  be  owing  only  to  variations  in  the  sub- 
sequent changes  in  the  ruptured  vesicle;  the  most  important  parts 
in  either  case  still  remaining  and  preserving  their  original  relations. 
The  principal  fact,  therefore,  to  be  established  in  the  present  me- 
moir may  perhaps  be  more  accurately  stated  as  follows  :  That  the 
presence  of  a  foetus  in  the  uterus  induces  certain  modifications  in 
the  growth  and  progress  of  the  corpus  luteum,  by  which,  during  a 
certain  period,  we  can  be  enabled  to  decide  with  certainty  that  preg- 
nancy has  existed ;  and  that  these  modifications  follow  a  regular 
course  of  progression  and  retrogression,  by  which  we  can  estimate, 
in  a  proximate  manner,  the  period  to  which  pregnancy  had  advanced 
at  the  time  of  death. 

The  importance  of  this  subject,  particularly  in  a  medico-legal 
point  of  view,  is  too  evident  to  require  notice. 

In  order  to  present  the  necessary  facts  and  arguments  to  the 
reader  in  the  most  convenient  form,  the  following  paper  will  be  di- 
vided into  three  parts. 


INTRODUCTION.  19 

The  first  will  embrace  the  history  and  description  of  the  corpus 
luteum  of  menstruation. 

The  second  will  contain  that  of  the  corpus  luteum  of  pregnancy, 
a  comparison  of  the  two,  and  an  inquiry  into  the  nature  of  the  dif- 
ferences between  them. 

The  third  will  contain  some  similar  observations  on  the  lower 
animals,  with  certain  conclusions  to  be  derived  therefrom. 


TAET  I. 
CORPUS  LUTEUM  OF  MENSTRUATION. 


OBSERVATION  I. 


Appearance  of  the  catamenia  during  the  course  of  acute  dysentery  ;  death  on 
the  following  day — A  Graafian  vesicle  in  one  ovary  recently  ruptured  and 
filled  with  blood — Other  Graafian  vesicles  in  active  development — Remains 
of  preceding  corpora  lutea — Decidua  already  nearly  separated  from  the  ute- 
rine surface. 

M.  K.,  set.  thirty-four,  an  inmate  of  the  Insane  Asylum  at  South 
Boston,  was  attacked  with  dysentery  on  Friday,  August  9th,  1850, 
and  died  on  the  following  Wednesday.  She  had  been  in  the  hospi- 
tal about  three  months,  suffering  from  a  mild  insanity,  from  which 
there  were  fair  hopes  of  her  recovery.  The  nurse  stated,  in  general 
terms,  that  the  patient's  catamenia  had  been  regular  since  her  en- 
trance. They  made  their  appearance  at  about  the  regular  period, 
on  the  day  preceding  death  ;  so  that  Dr.  Stedman,  the  physician 
of  the  asylum,  was  induced  to  hope  for  a  favourable  change  in  her 
disease.  They  ceased  again,  however,  the  same  night  or  the  follow- 
ing morning,  and  were  not  to  be  seen  on  the  day  of  death. 

The  autopsy  was  performed  on  Wednesday,  and  the  uterus  and 
ovaries  were  taken  out  and  given  to  me  on  the  Friday  following. 
There  was  no  menstrual  fluid  seen  in  the  vagina.  There  was  much 
inflammatory  alteration  of  the  mucous  membrane  over  nearly  the 
whole  extent  of  the  large  intestine. 

The  uterus  was  three  inches  long,  two  and  a  quarter  broad,  and  one 
and  three-sixteenths  thick.  On  cutting  open  the  organ,  it  was  found 
to  contain  a  flattened  triangular  mass,  corresponding  by  its  sides  and 
angles  to  the  shape  of  the  uterine  cavity,  which  it  entirely  occupied. 
It  was  of  a  dark  red  colour,  but  assumed  a  brighter  hue  after  a  few 
moments'  exposure  to  the  air.  Its  texture  was  soft  and  friable, 
while  at  the  same  time  it  showed  some  disposition  to  tear  in  strips, 
like  coagulable  lymph.     It  had  also  a  finely  granulated  appearance. 


22  PRIZE    ESSAY. 

The  greatest  thickness  of  the  mass  was  at  its  lower  extremity,  where 
it  approached  the  internal  orifice  of  the  cervix  uteri.  Here  it  was  one- 
sixteenth  of  an  inch  thick.  Superiorly,  it  terminated  in  a  thin  edge. 
The  whole  was  very  loosely  adherent  to  the  uterine  parietes,  from 
which  it  could  be  easily  separated,  leaving  the  uterine  surface  white, 
tolerably  smooth,  and  perfectly  firm.  Under  the  microscope,  it 
showed  the  following  appearances  :  1st.  Blood-globules,  rather  pale, 
but  not  materially  altered  in  size  or  shape.  2d.  Columnar  epithe- 
lium (from  the  oviducts).  3d.  Irregularly  roundish  bodies,  rather 
larger  than  blood-globules,  and  covered  with  very  distinct  granules. 
There  were  no  other  forms,  besides  these,  discovered  in  its  texture. 

The  right  ovary  was  an  inch  and  a  half  in  length,  of  a  yellowish- 
white  colour,  firm  and  condensed  in  texture,  and  much  puckered  by 
cicatrices.  Near  its  uterine  extremity,  and  on  its  posterior  aspect, 
there  was  a  rounded  prominence,  about  as  large  as  the  end  of  the 
little  finger.  This  prominence,  or  tumour,  was  considerably  reddened 
externally.  It  was  soft  and  yielding,  giving  to  the  fingers  quite  a 
distinct  sense  of  fluctuation.  The  ovarian  coats  were  unnaturally 
thin  all  over  the  prominence,  and  at  one  spot  the  tunica  albuginea 
was  wanting  ;  and  its  place  occupied  only  by  a  thin,  smooth  mem- 
brane (peritoneum),  through  which  appeared  the  dark  red  colour  of 
the  interior.  This  spot  was  nearly  semicircular  in  shape,  and  rather 
less  than  a  quarter  of  an  inch  long,  by  a  little  over  an  eighth  of  an 
inch  broad.  Its  edges  were  quite  sharply  defined,  looking  as  if  the 
tunica  albuginea  had  been  ruptured.  About  its  centre  was  a  very 
minute  perforation,  which  allowed  a  little  dark  blood  to  flow  out  on 
compressing  the  tumour,  but  which  was  too  small  to  be  distinctly 
seen  otherwise. 

On  dividing  the  ovary  longitudinally,  at  the  point  of  rupture,  a 
cavity  was  opened,  situated  immediately  beneath,  of  an  ovoid  shape, 
and  measuring  five-eighths  of  an  inch  in  its  long  diameter.  (See 
Plate  I,  Fig.  1.)  It  contained  seven  or  eight  drops  of  very  dark, 
thickish  blood,  and  a  very  dark,  almost  black  coagulum.  The  coagu- 
lum  lay  loose  in  the  cavity,  except  just  at  the  point  of  rupture,  where 
it  was  slightly  adherent  to  the  investing  membrane.  The  walls  of 
the  cavity  were  composed  of  a  single,  firm,  semi-transparent,  vascular 
membrane,  with  a  smooth  internal  surface,  which  could  be  readily 
stripped  off  entire  from  the  cut  surface  of  the  ovary.  There  was  no 
distinct  membrane  external  to  this,  though  irregular,  vascular-look- 
ing strips  of  cellular  tissue  could  still  be  raised  by  the  forceps. 


CORPUS  LUTEUM  OF  MENSTRUATION.         23 

There  was  no  yellow  matter  anywhere,  and  no  puckering  of  the 
membrane. 

There  -were  two  other  well-developed  Graafian  vesicles  in  this  ovary 
filled  with  clear  fluid  ;  one  of  them  nearly  as  large  as  the  bloody 
cavity  just  described. 

The  right  oviduct  was  free  and  pervious  throughout.  It  contained, 
particularly  toward  its  ovarian  extremity,  some  thick  whitish  fluid, 
which  under  the  microscope  showed  only  nucleated  columnar  epithe- 
lium. 

The  left  ovary  was  of  about  the  same  size  as  the  right,  and  simi- 
larly seamed  and  puckered.  It  had  upon  its  surface  two  Graafian 
vesicles,  filled  with  clear  fluid ;  the  larger  of  them  about  the  size  of 
a  small  hazelnut.  It  also  contained  one  or  two  soft,  granulous-look- 
ing,  thin,  compressed,  yellow  bodies,  the  remains  of  former  menstrua- 
tions. These  were  entirely  similar,  both  in  their  gross  and  micro- 
scopic characters,  to  the  other  retrograde  corpora  lutea,  hereafter  to 
be  described. 

The  left  oviduct  was  pervious  throughout,  and  contained  white 
fluid  like  that  in  the  ri";ht.  There  was  nothing  else  remarkable  about 
the  uterine  organs. 

This  case  has  several  points  of  interest.  In  the  first  place,  the 
condition  of  the  patient,  and  the  circumstances  under  which  she  was 
living,  are  such  as  almost  to  preclude  the  idea  of  any  sexual  inter- 
course having  taken  place.  Probably  we  should  never  be  able  to 
meet  with  a  case  where,  in  the  human  female,  the  rupture  of  a  Graa- 
fian vesicle,  independent  of  coition,  could  be  more  certainly  estab- 
lished than  in  the  present  instance. 

It  is  probable  that  the  patient's  illness  had  not  caused  any  very 
great  disturbance  in  the  periodical  return  of  the  menstrual  function, 
since  it  was  stated  that  it  had  heretofore  been  regular,  and  that  its 
return  at  that  time  was  only  "  a  little"  in  advance  of  the  expected 
period.  Still,  as  the  menstrual  flow  lasted  only  during  one  day,  it 
is  impossible  to  say  whether  this  corresponded  to  the  earlier  or  later 
part  of  its  regular  period  of  duration.  The  persistence  of  the  ova- 
rian function,  notwithstanding  the  grave  disease  under  which  the  pa- 
tient was  laboring  ;  the  fact  that  the  vesicle  was  burst,  and  filled  with 
blood,  but  had  not  yet  commenced  its  transformation  into  a  cor- 
pus luteum  ;  and  the  coincidence  in  time  between  the  rupture  of  the 
vesicle  and  the  separation  of  a  decidua  from  the  internal  surface  of 
the  uterus,  are  all  circumstances  which  deserved  particular  notice. 


24  PRIZE    ESSAY. 


OBSERVATION    II. 

Death  from  cholera  during  menstruation — Excessive  hemorrhage  into  a  Graa- 
fian vesicle — Decidua  (probably)  expelled — Old  corpora  lutea  in  the  opposite 
ovary. 

J.  C,  a  married  'woman,  thirty-eight  years  of  age,  died  at  the 
Cholera  Hospital  in  Boston,  Sept.  3d,  1849,  after  an  illness  of 
twenty  hours.     Her  general  health  was  stated  to  have  been  good. 

At  the  autopsy,  the  vagina  was  smeared  with  a  dingy  red  secre- 
tion. The  OS  uteri  was  rather  open,  and  purplish  in  colour.  The 
cavity  of  the  cervix  contained  a  little  adhesive  secretion.  The  uterus, 
generally,  was  of  natural  appearance,  and  measured  three  inches  in 
length,  two  in  breadth,  and  one  in  thickness.  Its  internal  sur- 
face was  quite  smooth,  firm,  and  pale,  without  any  appearance  like 
the  formation  of  a  decidua ;  but  was  smeared  with  a  reddish  fluid, 
like  that  of  menstruation. 

The  right  ovary  was  enlarged  to  six  or  eight  times  its  natural  size. 
It  was  ovoid  in  shape,  and  two  and  a  quarter  inches  long  ;  the  other 
measurements  in  proportion.  It  had  the  aspect  and  feel  of  a  serous 
cyst,  capable  of  containing  one  ounce  of  fluid  ;  but  the  red  colour  of 
its  contents  showed  through  at  the  thinner  part  of  its  walls.  It  was 
filled  with  a  dark,  tolerably  firm,  recent-looking  bloody  clot,  inter- 
sected by  one  or  two  very  delicate  enclosed  (false)  membranes.  The 
whole  clot  could  be  easily  turned  out,  leaving  a  very  red  smooth  lin- 
ing membrane,  with  several  spots  of  complete  ecchymosis  on  its  sur- 
face. The  clot  occupied  nearly  the  whole  of  the  organ  ;  the  proper 
structure  of  the  ovary  being  reduced  to  a  very  small  proportion  of 
the  whole. 

The  right  oviduct  was  somewhat  convoluted.  Its  ovarian  extremity 
was  closed  and  adherent  to  the  ovary.  It  could,  however,  be  easily 
dissected  off",  without  opening  the  cavity  of  either.  The  oviduct  was 
distended  so  as  to  contain  a  drachm,  or  more,  of  thinnish,  dingy-red 
fluid  similar  to  that  in  the  cavity  of  the  uterus.  Its  internal  surf\ice 
was  natural,  and  it  was  pervious  throughout,  except  at  its  ovarian 
extremity. 

The  left  ovary  was  one  and  three-quarters  of  an  inch  long.  It 
was  of  a  natural  form  and  colour,  and  had  several  cicatrices  on  its 
surface.     Internally,  it  contained  one  or  two  small,  old-looking  cor- 


CORPUS  LUTEUM  OF  MENSTRUATION.  25 

pora  lutea.  The  left  oviduct  was  free  from  adhesions.  Its  internal 
surface  was  smeared  with  a  small  quantity  of  whitish  fluid  secretion. 
The  amount  of  hemorrhage  in  this  case  was  so  great  as  perhaps 
almost  to  constitute  a  morbid  appearance.  It  shows,  however,  the 
connection  between  the  ovarian  hemorrhage  and  menstruation,  and 
the  expulsion  of  the  decidua  ;  which,  a  comparison  with  other  cases 
will  show,  had  probably  been  recently  thrown  off,  leaving  the  uterine 
surface  smooth  and  firm.  It  should  also  be  remembered  that  the 
patient's  "general  health"  was  said  to  be  good  ;  so  that  the  devia- 
tion from  a  normal  condition  was  not  probably  very  essential. 


OBSERVATION  III. 

Sudden  death  in  consequence  of  an  extensive  burn — A  Graafian  vesicle  in 
each  ovary  filled  with  blood,  and  the  internal  surface  of  the  uterus  soft  and 
shaggy. 

M.  M.,  a  remarkably  healthy-looking  and  well  developed  young 
woman,  unmarried,  twenty  years  of  age,  died  at  the  Mass.  Gen. 
Hospital,  January  29th,  1848.  Three  days  before,  she  had  suffered 
a  very  extensive  burn  in  consequence  of  the  bursting  of  a  camphene 
lamp,  by  which  the  skin  was  more  or  less  completely  destroyed  over 
the  greater  part  of  her  face,  neck,  body,  and  arms.  She  suffered  but 
little  pain  after  the  first  day,  and  finally  died  collapsed,  and  partially 
comatose.    No  information  was  obtained  regarding  her  menstruation. 

At  the  autopsy,  it  was  found  that  the  inner  surface  of  the  larynx 
was  extensively  scorched,  and  oedematous.  There  was  also  some 
pneumonia  of  the  right  lung.  The  uterus  was  of  natural  size  :  three 
inches  long,  by  two  broad.  Its  mouth  was  transverse,  and  sufficiently 
open  to  admit  the  end  of  the  little  finger.  The  cavity  of  the  uterus 
was  filled  with  an  abundant  reddish,  very  tenacious  secretion.  Its 
internal  surface  was  soft,  and  somewhat  shaggy.  Both  Fallopian 
tubes,  easily  laid  open  through  their  whole  extent,  contained  a  thick, 
yellowish,  opake  fluid. 

Both  ovaries  were  remarkably  large.  The  left  had  on  its  surface 
an  irregularly  oval  spot,  three-fourths  by  three-eighths  of  an  inch  in 
size,  where  the  investing  membranes  were  depressed,  thin,  and  red  ; 
very  distinct  from  the  remainder  of  the  surface,  which  had  its  usual 
thick,  yellow,  opake  appearance.  More  than  half  the  substance  of 
3 


26  PRIZE    ESSAY. 

the  ovary  was  occupied  by  a  roundish  cavity,  situated  immediately 
beneath  the  above-mentioned  spot,  and  filled  with  a  firm,  pretty  adher- 
ent coagulum,  dark  red  internally,  more  yellowish  externally.  The 
lining  membrane  of  the  cavity,  immediately  external  to  the  coagulum, 
was  of  a  dull  red  and  brownish  colour,  and  opake.  It  was  mode- 
rately adherent,  but  could  be  raised  and  separated  entire.  External 
to  this  were  cellular  layers,  which  could  only  be  raised  in  strips,  the 
outermost  of  which  were  intimately  connected  with  the  ovarian  tissue. 
The  opposite  ovary  had  a  similar  spot  on  its  surface,  and  a  bloody 
cavity  underneath.  The  coagulum  here  was  rather  less  firm  than 
the  other,  and  had  a  fresher  appearance.  The  surrounding  mem- 
brane could  not  be  so  easily  traced. 

The  history  of  this,  case  being  somewhat  imperfect,  it  does  not 
afibrd  any  direct  proof  of  the  connection  between  ovarian  hemorrhage 
and  menstruation.  A  comparison  with  other  observations,  however, 
makes  it  probable  that  menstruation  had  either  just  terminated,  or 
was  suppressed  by  the  accident  which  resulted  in  death.  The  case 
is  somewhat  remarkable,  like  the  last,  for  the  large  amount  of  blood 
efi'used  within  the  Graafian  vesicle,  and  shows,  moreover,  the  con- 
nection of  the  ovarian  hemorrhage  with  the  softening  of  the  uterine 
surface. 


OBSERVATION   IV. 

Piapld  death  from  cholera — A  Graafian  vesicle  filled  with  blood,  and  just 
commencing  the  transformation  into  a  corpus  luteum — Softening  of  the 
uterine  surface. 

E.  D.,  unmarried,  thirty-six  years  of  age,  died  at  the  Cholera 
Hospital  in  Boston,  Sept.  11th,  1849,  after  an  illness  of  eighteen 
hours.  No  information  was  obtained  regarding  the  patient's  men- 
struation, but  she  was  stated  to  have  been  in  her  "  usual  health" 
until  the  period  of  attack. 

The  vagina  was  smeared  with  a  moderate  quantity  of  the  ordinary 
starchy  secretion  of  cholera.  The  uterus  measured  three  and  three- 
eighth  inches  in  length,  one  and  seven-eighths  in  breadth,  and  one 
and  a  quarter  in  thickness.  It  was  firm  and  pale  anteriorly,  but 
posteriorly  had  rather  a  tumefied  appearance,  and  in  its  posterior 
wall  it  contained  a  fibrous  tumour,  a  quarter  of  an  inch  in  diameter, 


CORPUS  LUTEUM  OF  MENSTRUATION. 


27 


near  Avliicli  the  uterine  substance  was  somewhat  reddened  and  soft- 
ened. Elsewhere  it  was  natural  The  os  uteri  was  small  and  round, 
the  cervix  pale,  firm,  and  empty.  The  internal  surface  of  the  body 
of  the  organ  was  much  softened  and  reddened  to  the  depth  of  three- 
sixteenths  of  an  inch.  It  was,  in  fact,  converted  for  that  depth  into  a 
dark  purplish  red,  soft,  shaggy  coat,  in  which  numerous  slender,  wavy 
fibres  were  distinctly  visible,  projecting  toward  the  interior.  This 
reddened  coat  was  suflSciently  tender  to  be  scraped  off  with  consider- 
able readiness  by  the  edge  of  the  knife,  leaving  the  uterine  surface 
pale,  and  somewhat  uneven.  It  was  confined  to  the  body  of  the 
organ,  and  did  not  descend  at  all  into  its  neck. 

The  right  ovary  was  one  and  seven-eighth  inches  in  length.  Nearly 
half  of  it  was  occupied  by  a  loose,  fluctuating  tumour,  having  much 
the  appearance  of  a  serous  cyst,  only  the  red  colour  of  its  contents 
showed  through.  It  was  roundish  and  bulging,  and  at  its  most 
prominent  part  showed  a  small  abraded  spot,  but  nothing  like  a  well- 
marked  cicatrix.  Internally,  it  presented  a  cavity  which  was  filled 
partly  with  a  thin  bloody  fluid,  and  partly  with  a  tolerably  firm, 
adherent  coagulum,  from  which  the  red 
colouring  matter  had  not  yet  been  com-  °'   ' 

pletely  absorbed.  The  walls  of  the  cavity 
consisted  apparently,  at  its  bulging  ex- 
tremity, of  the  thinned  and  distended 
coats  of  the  ovary,  but  at  its  deeper  part 
of  a  yellowish,  well-defined  layer  of  mo- 
derately firm  consistency,  and  irregularly 
folded  and  convoluted,  like  the  convolu- 
tions of  the  brain.  This  yellow  layer 
had  a  thickness  at  the  deepest  part  of 
the  tumour,  of  one-sixteenth  of  an  inch ; 
but  it  gradually  became  thinner  as  it  ap- 
proached the  surface,  until  it  appeared  to 
blend  with  the  coats  of  the  ovary. 

The  left  ovary,  one  and  a  quarter  inches  long,  contained  three  or 
or  four  moderately  developed  Graafian  vesicles.  There  was  nothing 
remarkable  about  cither  oviduct. 


Commencement  of  formation  ol 
the  corpus  luteum. 


28  PRIZE    ESSAY. 


OBSERVATION   V. 

Corpus  luteum  of  menstruation  of  about  two  weeks'  date — Another,  in  the  oppo- 
site ovary,  in  a  retrograde  condition — Softening  of  the  uterine  surface. 

M.  H.,  a  servant  girl,  aged  twenty-two,  of  a  plump  and  healthy 
aspect,  died  at  the  Cholera  Hospital,  in  Boston,  Sept.  16th,  1849,  after 
an  illness  of  but  little  over  thirty  hours.  In  the  recorded  history  of 
her  case,  it  was  stated  that  she  had  "menstruated"  two  weeks  pre- 
viously, but  no  account  was  obtained  of  the  exact  time  at  which  the 
flow  commenced  or  terminated. 

At  the  autopsy,  the  vagina  was  found  smeared  with  a  starchy  secre- 
tion. The  OS  uteri  was  rather  open.  The  cavity  of  the  cervix  con- 
tained a  very  little  glutinous  secretion,  and  its  internal  surface  showed 
one  or  two  distended  follicles  beneath  the  lining  membrane.  The 
body  of  the  uterus  was  empty  and  of  natural  appearance ;  firm  and  whit- 
ish. Its  internal  surface  was  softened  to  the  depth  of  three-sixteenths  of 
an  inch,  and  converted  into  a  loose,  vascular,  shaggy  texture,  in  which 
fine  zigzag  vessels,  intermixed  with  whitish  fibres,  were  distinctly 
visible,  forming  very  much  the  same  appearance  as  that  described  in 
the  preceding  observation.  The  uterus  measured  three  inches  in 
length,  one  in  thickness,  and  one  and  three-quarters  in  breadth. 

The  left  ovary,  one  and  three-quarter  inches  in  length,  contained 
at  one  extremity  a  roundish,  ovoid  tumour,  measuring  five-eighths  of 
an  inch  in  its  long  diameter.  It  was  composed  of  a  light-yellow  ex- 
ternal layer,  strongly  folded  and  convoluted,  and  enclosing  a  fibrinous, 
semi-translucent  coagulum,  stained  with  some  remains  of  the  colour- 
ing matter. 

The  yellow  wall  of  this  corpus  luteum  was  invested  by  a  delicate 
external  membrane,  with  which  it  could  be  enucleated  entire  from 
the  ovary.  Its  texture  was  friable  and  granular.  On  superficial 
examination,  it  appeared  to  contain  some  bundles  of  fine  vessels,  pro- 
ceeding from  without  inward  ;  but  on  closer  inspection  they  were 
seen  to  exist  only  in  the  interstices  between  the  convolutions,  where 
they  had  been  accidentally  exposed  in  making  the  section  ;  in  the 
same  manner  as  the  vessels  of  the  pia  mater  may  be  exposed,  dipping 
down  between  the  convolutions  of  the  brain.  The  substance  of  the 
yellow  wall  itself  contained  no  vessels. 

The  tumour  formed  by  this  corpus  luteum  had  just  firmness  sufiicient 
to  allow  its  contour  to  be  felt  through  the  ovarian  texture ;  but  it 


CORPUS  LUTEUM  OF  MENSTRUATION. 


29 


had  very  little  resistance,  and  might  easily  have  been  crushed  be- 
tween the  thumb  and  finger.  Before  being  cut  open,  it  even  gave  an 
indistinct  and  deceptive  sense  of  fluctuation. 

The  following  represents  the  ovary,  of  natural  size,  cut  open  lon- 
gitudinally. 

Fig.  2.  Fig.  3. 


Corpus  luteum  of  menstruation 
about  two  weeks  old. 


Corpus  luteum  of  menstruation  of 
about  six  weeks. 


The  opposite  ovary  was  of  natural  size  and  appearance.  It  con- 
tained at  one  spot,  immediately  beneath  its  surface,  a  small  flattened 
cavity,  a  quarter  of  an  inch  in  diameter.  The  cavity  had  no  bloody 
contents,  but  was  surrounded  by  a  thin  wall,  of  a  dull  yellowish 
colour,  Avhich  showed  indistinct  appearances  of  being  more  or  less 
convoluted.  This  wall  was  surrounded  by  a  thin  delicate  membrane, 
with  which,  like  the  other,  it  could  be  enucleated  from  the  substance 
of  the  ovary.     A  drawing  of  it  is  given  above  (Fig.  3). 

The  ovaries  also  contain  several  Graafian  vesicles  in  active  deve- 
lopment. Both  oviducts  were  in  a  natural  condition,  and  contained 
only  a  little  whitish  fluid. 


OBSERVATION   Yl. 

Corpus  luteum  of  menstruation,  three  weeks  from  the  termination  of  the  men- 
strual period — at  its  maximum  of  development — Five  others,  in  difi'erent 
stages  of  retrogression — Uterine  surfiice  soft,  but  pale. 

L.  E.  B.,  a  factor}''  operative  at  Lowell,  unmarried,  twenty  years  of 
age,  was  attacked  with  hsemoptysis  on  Friday,  June  28th,  1850,  at 


30  PRIZE    ESSAY. 

eight  P.  M.,  while  walking  in  the  street,  and  died  the  next  morning 
at  four.  The  uterus  and  ovaries  were  taken  out  at  the  autopsy,  and 
sent  to  me  by  Dr.  J.  0.  Dalton,  Sr.,  by  whom  the  following  par- 
ticulars, relating  to  menstruation,  &c.,  were  also  ascertained. 

The  girl  had  been  in  perfectly  good  health  for  many  months,  and 
had  menstruated  for  the  last  time  just  three  weeks  previous  to  her 
death.  This  last  fact  was  ascertained  of  the  patient's  landlady,  who 
had  inquired  particularly  concerning  it  of  the  girl's  sisters,  imme- 
diately after  her  death.  The  sisters  worked  in  the  same  mill,  and 
boarded  in  the  same  house.  It  was  undoubtedly  meant  that  the  girl 
had  ceased  menstruating  just  three  weeks  before  ;  since  it  was  also 
remarked  that  she  was  then  "within  a  week  of  her  time."  The  body 
generally  "appeared  somewhat  exsanguious,  and  the  lungs  very  much 
engorged.  No  tubercles,  but  one  old  ulcer,  as  large  as  a  shagbark, 
lined  with  false  membrane,  at  the  right  apex  ;  near  which  was  a  strong 
pleuritic  adhesion.     Other  thoracic  and  abdominal  organs  healthy." 

The  uterus  was  empty,  and  of  natural  appearance  externally.  Its 
internal  surface  was  pale,  but  softened  to  the  depth  of  about  a  quarter 
of  an  inch,  exhibiting  distinctly  the  velvety,  shaggy  appearance  al- 
ready described. 

The  right  ovary  was  one  inch  and  seven-eighths  in  length.  Its 
surface  was  generally  smooth,  and  pale  yellowish  in  colour,  and 
showed  only  here  and  there  a  very  few  fine  superficial  vessels.  Its 
outer  extremity  presented  a  rounded  tumour,  about  the  size  of  the  end 
of  the  finger,  imbedded  in  the  substance  of  the  ovary,  but  projecting 
slightly  from  its  posterior  surface  (Plate  I.  Fig.  2).  It  was  globular 
in  shape,  and  had  but  little  solidity,  feeling  as  if  it  might  easily  be 
crushed  between  the  thumb  and  finger.  The  surface  of  the  ovary, 
over  the  tumor,  was  quite  vascular,  showing  many  red  and  blue  ves- 
sels. At  about  its  most  prominent  part  was  a  cicatrix ;  i.  e.,  a  small 
oval  spot,  very  slightly  depressed,  about  one-twentieth  of  an  inch  in 
length,  where  the  tunica  albuginea  was  entirely  wanting,  and  its 
place  supplied  by  a  thin,  delicate,  transparent  membrane,  which  al- 
lowed the  pale  reddish  colour  of  the  contents  of  the  tumour  to  show 
through. 

On  making  a  longitudinal  section  of  the  organ,  through  the  cica- 
trix, the  corpus  luteum  was  exposed  (Plate  I.  Fig.  3,  a).  It  was 
three-quarters  of  an  inch  in  its  long  diameter,  and  nearly  one-half 
an  inch  in  depth.  It  consisted  of  a  thin,  pale,  reddish-yellow,  irregu- 
larly convoluted  wall,  enclosing  a  solid,  semi-transparent,  fibrinous 
coagulum,  which  showed  in  various  parts  remains  of  the  red  colour- 


CORPUS  LUTEUM  OF  MENSTRUATION.         31 

ing  matter  of  the  blood.  There  was  no  empty  cavity.  The  wall 
was  thickest  at  the  deepest  part  of  the  tumour,  and  grew  gradually 
thinner  as  it  approached  the  surface  and  the  situation  of  the  external 
cicatrix,  where  finally  it  was  entirely  wanting  ;  showing  conclu- 
sively that  the  rupture  of  the  Graafian  vesicle  had  taken  place  at 
this  spot. 

The  relative  proportions  of  the  convoluted  wall  and  its  contents 
are  represented  in  the  drawing.  The  wall  itself  was  not  lined  by 
any  membrane,  but  was  in  immediate  contact  with  the  fibrinous  coagu- 
lum.  Externally,  it  was  invested  by  a  thin,  semi-transparent,  vas- 
cular membrane,  with  which  it  could  be  readily  enucleated  from  the 
substance  of  the  ovary,  leaving  a  smooth  and  somewhat  vascular 
surface  of  condensed  cellular  tissue.  This  investing  membrane  was 
intimately  connected  with  the  substance  of  the  yellow  wall,  and 
could  not  readily  be  separated  from  it;  so  that,  when  raised  in  strips, 
portions  of  the  wall  adhered  to  it.  The  interstices  of  the  convolu- 
tions were  vascular,  but  no  vessels  could  be  detected  in  the  substance 
of  the  yellow  wall  itself. 

Toward  the  uterine  extremity  of  the  ovary,  there  was  another 
yellow  body  (Plate  I.  Fig.  3,  b),  much  smaller  than  the  first,  situ- 
ated immediately  beneath  a  minute  transparent  cicatrix  on  the  sur- 
face, which  was  surrounded  by  a  slight  vascularity.  The  colour  of 
this  body  was  a  much  more  decided  yellow  than  that  of  the  first. 
It  appeared  to  consist  of  a  wall,  the  opposite  sides  of  which  were 
nearly  or  quite  in  contact,  owing  to  the  absorption  of  the  contained 
coagulum.  The  wall  also  showed  some  indications  of  a  convoluted 
arrangement ;  but  the  whole  body  was  so  small,  and  its  texture  so 
friable,  that  it  was  difiicult  to  establish  this  point  distinctly. 

At  a  short  distance  was  situated  another  yellow  body,  similar  in 
character  to  that  last  described,  only  much  smaller. 

The  left  ovary  was  one  inch  and  five-eighths  long.  It  showed 
on  its  surface  several  cicatrices,  both  shallow  and  depressed,  and 
contained  three  very  small,  obsolete  yellow  bodies,  like  those  de- 
scribed as  found  in  the  right  ovary. 

Both  ovaries  contained  many  Graafian  vesicles,  in  different  stages 
of  active  development,  but  neither  showed  anything  else  at  all  re- 
sembling a  corpus  luteum. 

Both  oviducts  were  free  and  natural  in  appearance  throughout. 


32 


PRIZE    ESSAY. 


OBSERVATION  VII. 


Corpus  luteum  of  menstruation  of  about  the  same  date  as  the  preceding — Soft- 
ening of  the  uterine  surface. 

E.  B.,  a  •widow,  thirty  years  of  age,  died  at  the  Cholera  Hospital 
in  Boston,  August  20th,  1849,  after  an  illness  of  ten  and  a  half 
hours.  No  information  was  obtained  regarding  her  menstruation, 
but  she  was  "as  well  as  usual"  till  the  period  of  her  attack.  The 
abdomen,  externally,  showed  many  scars  of  pregnancy. 

The  uterus  was  somewhat  "bombde"  posteriorly,  and  had  rather 
a  softish  feel.  It  was  empty.  Its  internal  surface  was  much  soft- 
ened and  reddened  to  the  depth  of  three-sixteenths  of  an  inch,  hav- 
ing undergone  the  same  change  already  described  in  previous  obser- 
vations. The  internal  surface  of  the  cervix  uteri  was  pale,  and  had 
but  little  of  the  adhesive  secretion  in  its  cavity ;  but  one  or  two 
follicles,  distended  with  this  secretion,  could  be  seen  beneath  its 
mucous  membrane.  The  uterus  measured  three  and  a  quarter  inches 
in  length,  and  two  and  a  quarter  in  breadth.  (The  subject  was 
large  and  stout.) 

The  right  ovary  was  one  inch  and  three-eighths  long  ;  generally 

white  and  natural  in  appearance.    One 
Y[cr,  4.  end  of  it  was  occupied  by  an  ovoid  tu- 

mour, not  very  firm  to  the  touch,  the 
dull  reddish  colour  of  which  showed 
through  the  integuments  of  the  ovary. 
A  section  of  the  ovary  showed  the  tu- 
mour to  be  three-quarters  of  an  inch 
long,  by  nearly  half  an  inch  deep.  It 
consisted,  like  the  others,  of  a  yellow 
convoluted  wall,  which  enveloped  a 
homogeneous,  opaline,  greenish,  fibrin- 
ous-looking  coagulum,  which  still  pre- 
sented, in  spots,  some  traces  of  the 
colouring  matter  of  the  blood. 
The  point  of  rupture  is  not  seen  in  this  drawing ;  probably  because, 
in  making  the  section,  sufficient  care  was  not  taken  to  cut  through 
the  cicatrix. 


Corpus  luteum  of  menstruation 
of  about  three  weeks. 


CORPUS  LUTEUM  OF  MENSTRUATION. 


33 


OBSERVATION  VIII 


Death  during  tlie  menstrual  period — Corpus  lutcum  of  the  last  menstruation 
commencing  to  diminish  in  size — Graafian  vesicle  not  yet  burst — Decidua 
just  separated  from  the  uterine  surface. 

C.  M.,  a  married  -woman,  thirty  years  of  age,  died  at  the  Cholera 
Hospital  in  Boston,  August  23d,  1849,  after  an  illness  of  four  days. 
She  was  said  to  have  had  her  usual  health  till  the  time  of  the  attack. 

The  uterus  Tvas  rather  large,  particularly  in  proportion  to  the 
size  of  the  patient,  Avho  was  small  and  slightly  built.  It  measured 
three  and  three-eighths  inches  in  length,  tAvo  and  a  half  in  breadth, 
and  one  and  a  half  in  thickness.  It  was  much  bulging  posteriorly, 
and  had  altogether  a  tense,  stiff,  swollen  aspect  and  feel.  The  os 
uteri  was  widely  open.  The  cavity  of  the  cervix  was  filled  with  an 
abundance  of  tough,  tenacious  secretion,  strongly  coloured  with  blood. 
The  vagina,  also,  and  external  organs  were  smeared  with  a  bloody 
fluid. 

The  internal  surface  of  the  body  of  the  uterus  was  quite  pale  and 
smooth,  without  any  appearance  of  the  softening  elsewhere  described; 
but  its  cavity  contained  a  flattened  triangular  mass,  like  that  men- 
tioned in  Observation  I,,  of  a  reddish-gray  colour  and  loose  texture, 
having  no  appearance  of  an  organized  structure,  nor  any  attachment 
to  tlie  walls  of  the  uterus.  It  had  evidently  taken  its  shape  from 
that  of  the  uterine  cavity,  its  two  upper  angles  corresponding  to  the 
orifices  of  the  oviducts.  Its  longitudinal  diameter  was  a  little  over 
one  inch ;  its  transverse,  at  its  widest  part,  something  less. 

The  left  ovary,  one  and  a  half  inches  in  length,  had  a  natural 
colour  and  appearance  externally.  At 
the  uterine  extremity  of  the  organ  was 
a  spot  where  the  integuments  were 
thinned,  and  the  reddish  colour  of  the 
corpus  between  showed  through.  The 
tumour  was  ovoid  in  shape,  but  had 
very  little  firmness,  or  resistance  to  the 
touch.  It  consisted  of  a  thin,  yellow, 
very  irregular,  convoluted  wall,  and 
an  internal  greenish,  semi-transparent, 
fibrinous  clot,  stained  with   some  re- 

Corpus  luteiim  of  menstruation  of 

mams  of  red  colourmg  matter.    There  nearly  four  weeks. 


34  PRIZE    ESSAY. 

"was  no  strongly-marked  cicatrix  on  the  surface  of  the  ovary.  The 
accompanying  drawing  (Fig.  5)  represents  the  ovary  and  corpus 
luteum,  of  the  natural  size.  The  left  oviduct  was  empty  and  pale 
internally. 

The  right  ovary,  of  about  the  same  size  as  the  left,  presented 
several  Graafian  vesicles,  moderately  developed.  The  right  oviduct 
contained,  in  its  uterine  half,  a  considerable  amount  of  thickish, 
bloody  fluid  ;  otherwise  it  was  natural. 


OBSERVATION    IX. 

Death  just  at  the  termination  of  a  menstrual  period — A  Graafian  vesicle 
prominent,  and  on  the  point  of  bursting — Corpus  luteum  of  the  preceding 
menstruation,  in  a  retrograde  condition — Seven  others,  quite  atrophied  and 
obsolete — Uterine  surface  pale,  but  soft. 

Mrs.  a.,  a  widow,  forty-five  years  of  age,  a  patient  of  Dr.  W.  H. 
Thayer,  was  attacked  suddenly  with  apoplexy,  Oct.  14th,  1850,  at 
5  P.  M. ;  and,  after"  lying  insensible  for  sixteen  hours,  died  on  the 
following  morning.  Mrs.  A.'s  youngest  child  was  about  twelve 
years  of  age.  Her  husband  had  been  dead  ten  years.  Her  maid- 
servant, an  intelligent  girl,  reported  to  Dr.  Thayer  that  Mrs.  A.'s 
catamenia  had  been  regular  at  intervals  of  four  weeks,  from  com- 
mencement to  commencement ;  and  that  they  always  continued  a 
week,  accompanied  with  much  pain  in  the  pelvic  region,  sometimes 
so  great  as  to  oblige  her  to  keep  her  bed  for  a  day.  Her  last  cata- 
menial  period  closed  on  Sunday  the  loth,  the  day  before  her  attack, 
as  Mrs.  A.  had  herself  told  her.  She  was  in  general  well  acquainted 
with  the  course  of  her  mistress's  catamenia,  as  she  washed  her  linen, 
and  was  also  a  kind  of  confidential  servant. 

At  the  autopsy,  Oct.  16,  twenty-five  hours  after  death,  a  hemorrhage 
of  about  three  ounces  was  found  in  the  substance  of  the  right  hemi- 
sphere of  the  brain,  and  another,  much  smaller,  in  the  right  optic 
thalamus.  The  cerebral  substance  was  much  softened  in  the  imme- 
diate neighbourhood  of  each  coagulum.  There  was  also  considerable 
hypertrophy  of  the  left  ventricle  of  the  heart,  but  the  other  organs 
were  healthy.     The  stomach  contained  much  undigested  food. 

The  uterus  was  quite  large,  measuring  three  and  a  half  inches  in 
length,  and  two  and  a  quarter  in  its  transverse  diameter.     Its  walls 


CORPUS  LUTEUM  OP  MENSTRUATION.         35 

"were  proportionably  thick,  but  natural  in  texture.  It  was  empty. 
Its  internal  surface  was  rather  pale,  but  quite  soft,  shaggy,  and 
velvety  in  appearance.  The  os  uteri  was  transverse,  wide,  and  much 
fissured. 

The  left  ovary  was  an  inch  and  five-eighths  long.  It  contained 
two  large  and  somewhat  prominent  Graafian  vesicles,  with  clear  fluid 
contents.  One  of  them  was  particularly  distended  and  prominent; 
being  covered,  over  a  considerable  part  of  its  surface,  by  peritoneum 
alone.  On  the  anterior  surface  of  the  organ  was  an  irregularly 
oval  spot,  three-eighths  of  an  inch  long,  where  the  tunica  albuginea 
was  wanting.  Immediately  beneath  was  a  corpus  luteum,  the  bright 
yellow  colour  of  which  showed  through  the  peritoneal  coat.  There 
was  also  a  black  speck  upon  its  surface,  which  marked  the  spot  where 
the  rupture  of  the  vesicle  had  taken  place.  On  making  a  section  of 
the  ovary,  through  this  black  spot,  the  corpus  luteum  was  exposed, 
of  a  somewhat  flattened,  oval  shape,  three-eighths  of  an  inch  in 
length,  and  a  little  over  a  quarter  of  an  inch  in  depth.  (Plate  I. 
Fig.  4.)  It  consisted,  like  the  others,  of  a  bright  yellow,  pulpy, 
friable  wall,  thickest  at  its  deepest  part,  and  gradually  thinning  off 
toward  the  situation  of  the  rupture  ;  strongly  folded  upon  itself,  and 
destitute  of  vessels.  It  enclosed  a  little,  very  dark,  moderately 
firm  coagulum,  which  was  easily  removed,  having  no  organic  connec- 
tion with  the  yellow  wall.  The  Avail  itself  was  not  lined  by  any 
membrane,  but  vfas  in  immediate  contact  with  the  coagulum.  When 
put  upon  the  stretch,  it  Avas  not  more  than  one-twentieth  of  an  inch 
in  thickness;  but,  when  allowed  to  remain  folded  up,  appeared  some- 
what thicker.  It  could  easily  be  enucleated  entire,  and  externally 
had  the  same  relations  to  the  investing  membrane  and  the  substance 
of  the  ovary  as  in  the  preceding  cases. 

The  same  ovary  contained  two  other  old  corpora  lutea,  one  of 
them  about  a  quarter  part  the  size  of  the  first,  the  other  still 
smaller.  They  were  both,  in  their  general  characters,  similar  to 
the  first.  The  larger  had  also  a  small  black  spot  on  its  surface, 
marking  the  situation  of  the  rupture  ;  and  a  section  being  made  at 
a  little  distance  from  this  spot,  the  foldings  of  the  wall  were  dis- 
tinctly seen  to  radiate  from  it. 

The  right  ovary  was  one  and  three-quarters  of  an  inch  long.  Its 
section  discovered  a  yellow  body,  about  a  quarter  of  an  inch  in 
length,  much  flattened,  and  containing  a  little  very  dark  blood. 
There  were  also  four  others,  perfectly  distinguishable,  but  diminish- 
ing successively  in  size ;  all  superficially  situated  beneath  shallow 


36  PRIZE    ESSAY. 

or  moderately  depressed  cicatrices.  The  two  smallest,  alone,  con- 
tained no  noticeable  remains  of  blood.  They  were  all  similar  in 
structure,  but  the  smaller  were  whiter,  and  of  a  less  decided  yellow, 
than  the  larger.     There  were  no  other  remarkable  appearances. 

Both  oviducts  were  quite  natural.  They  contained  only  a  little 
opake,  whitish  secretion,  which,  under  the  microscope,  showed  an 
abundance  of  ciliated  epithelium. 

Everything  makes  it  probable  that,  in  this  instance,  the  largest 
corpus  luteum  was  the  result  of  the  last  menstruation  but  one,  and 
that  the  most  prominent  vesicle  on  the  left  ovary  was  just  upon  the 
point  of  bursting  when  the  patient  suffered  her  attack  of  apoplexy. 

So  far  this  case,  together  with  the  preceding,  would  go  to  sustain 
the  opinion  of  Pouchet  and  Raciborski,  that  the  ovum  is  discharged 
in  the  human  female,  not  during,  but  at  the  termination  of,  the  men- 
strual period. 


OBSERVATION  X. 

Death  from  inflammation  of  the  brain  of  several  ■weeks'  standing — Corpus 
luteum  of  menstruation  thirty  days  after  the  termination  of  the  menstrual 
period — Three  others  still  more  obsolete — No  prominent  Graafian  vesicles — 
Uterine  surface  only  a  little  softened. 

M.  A.,  a  married  woman,  twenty-nine  years  of  age,  who  had  had 
one  child  four  years  ago,  entered  the  Almshouse  Hospital  at  South 
Boston,  June  10tli,1850,  suffering  from  symptoms  resembling  chorea. 
They  consisted  in  a  capricious,  semi-involuntary,  twisting  motion  of 
the  right  arm  and  hand,  and  some  disposition  to  a  drawing  up  of 
the  left  leg.  There  was  also  an  almost  constant,  slow  winking 
motion  of  the  right  eyelid,  accompanied  by  a  sinister  leering  expres- 
sion of  the  countenance,  as  if  the  patient  were  partially  idiotic  or 
hysterical.  The  intelligence  was  rather  dull,  but  otherwise  not 
much  altered. 

She  was  treated  with  antimonials,  low  diet,  and  blisters  to  the 
back  of  the  neck  ;  afterwards  by  carbonate  of  iron  and  full  diet. 

Under  this  treatment  she  improved  much,  and  on  the  29th  of 
June,  being  to  all  appearance  well,  was  discharged  from  the  Hos- 
pital and  sent  to  the  Almshouse.  Two  days  afterward,  however, 
she  returned,  suffering  under  a  fresh  attack,  much  more  severe  than 


CORPUS  LUTEUM  OF  MENSTRUATION.         37 

the  former.  This  time  she  had  lost  much  of  her  muscular  power ; 
and  lay  nearly  prone  on  the  floor  of  the  ward,  apparently  unable  to 
rise,  and  very  stupid.  After  much  urging,  she  managed  to  raise 
herself  from  the  ground  with  the  assistance  of  a  chair,  but  had 
great  difficulty  in  doing  so.  There  was  some  paralysis  of  the  left 
side,  and  a  want  of  control  over  the  muscles  of  the  right.  She  was 
treated  with  purgatives  and  counter-irritation  to  the  head  and  spine, 
but  sunk  into  a  deeply  typhoid  condition,  and  died  on  the  12th  of 
July. 

The  nurse  reported  that  the  patient  was  menstruating  at  the  time 
of  her  first  entrance  into  the  hospital,  and  continued  to  do  so  June 
10th  and  11th.  On  the  12th,  the  discharge  returned  slightly,  and 
then  finally  ceased.  The  nurse  was  positive  that  she  had  had  no 
menstruation  since,  as  she  must  have  known  it,  if  such  had  been  the 
case.  There  was  found  much  inflammatory  softening  of  the  right 
hemisphere  of  the  brain,  and  of  the  right  corpus  striatum ;  some 
also  of  the  right  optic  thalamus  and  of  the  left  hemisphere. 

The  uterus,  of  about  the  normal  size,  was  somewhat  retroverted, 
and  inclined  to  the  left  side  of  the  pelvis,  where  it  was  confined  by 
numerous  old,  organized,  bridle-shaped  adhesions.  It  was  empty. 
Its  internal  surface  was  quite  vascular  and  a  little  pulpy,  but  much 
less  so  than  in  some  of  the  preceding  observations,  as  the  pulpy 
portion  at  its  thickest  part  did  not  exceed  one-sixteenth  of  an  inch. 

The  right  ovary  was  one  inch  in  length  ;  white,  firm,  and  covered 
with  cicatrices.  It  contained  two  yellow  bodies.  (Plate  I.  Fig.  5). 
The  larger  Avas  flattened  from  without  inward,  and  contained  within 
the  yellow  wall  an  appreciable  amount  of  reddish  fibrin  which  could 
be  easily  separated  from  its  cavity.  This  body  was  a  little  over  a 
quarter  of  an  inch  in  its  long  diameter.  It  was  situated  immedi- 
ately beneath  a  strongly  depressed  cicatrix  on  the  surface  of  the 
ovary.  On  very  minute  examination  traces  of  the  convoluted 
arrangement  of  its  walls  were  visible. 

The  second  body  was  irregularly  globular  in  shape,  and  much 
smaller  than  the  first.  Its  centre  was  occupied  by  a  radiated  cica- 
trix, which  no  longer  contained  any  noticeable  amount  of  coagulum. 
The  right  ovary  also  contained  one  more  very  minute  yellow  body, 
too  small  to  show  any  definite  structure.  There  was  also  one  more 
in  the  left  ovary,  but  nothing  else  in  either  that  presented  any  ap- 
pearance like  that  of  a  corpus  luteum. 

There  were  but  very  few  Graafian  vesicles  to  be  seen,  and  these 
were  small  and  of  an  inactive  appearance. 


38  PRIZE    ESSAY. 

The  right  oviduct  was  much  convoluted,  and  confined  by  adhe- 
sions. The  fimbriated  extremity  was  entirely  adherent  to  the  ovary, 
enclosing  an  oval  space  on  the  surface  of  the  organ  five-eighths  of 
an  inch  long.  The  oviduct  was  somewhat  distended,  and  contained 
about  half  a  drachm  of  thickish,  brownish-red  fluid,  approaching  to 
bistre  in  its  colour.  The  internal  surface  was  vascular,  and  stained 
by  the  brownish  fluid ;  otherwise  natural.  The  left  oviduct  was 
adherent  like  the  right,  but  empty  and  collapsed.  It  was  imper- 
vious in  two  or  three  spots,  toward  its  uterine  extremity.  But  the 
right  was  pervious  throughout. 


OBSERVATION    XI. 

Absence  of  catamenia  for  over  two  months — Corpus  luteum  of  last  period  very 
small — Four  others,  quite  obsolete — No  softening  of  uterine  surface. 

M.  S.,  unmarried,  twenty-three  years  of  age,  died  at  the  Massachu- 
setts General  Hospital,  Aug.  26th,  1850,  of  tubercular  meningitis. 

She  entered  the  house  Aug.  18th,  at  which  time  her  intelligence 
was  so  much  afiected,  that  she  was  unable  to  give  any  account  of 
herself.  Her  sister,  however,  reported  that  she  had  had  no  cata- 
menia for  two  months,  and  none  appeared  while  she  was  in  the  hos- 
pital ;  making,  in  all,  a  period  of  two  months  and  eight  days  that 
the  catamenia  had  been  absent. 

At  the  autopsy,  the  substance  of  the  brain  was  found  somewhat 
softened,  with  a  rather  copious  eff"usion  of  serum  into  its  cavities, 
and  an  abundance  of  minute,  whitish,  opake  (tuberculous)  grains, 
scattered  through  the  meshes  of  the  pia  mater  between  the  convolu- 
tions ;  more  particularly  at  the  base  of  the  brain.  The  pleurae  were 
also  sprinkled  with  tuberculous  granulations,  without  the  existence 
of  any  considerable  collection  in  the  pulmonary  substance.  The 
liver  and  spleen  also  showed  an  abundance  of  similar  tubercles  in 
their  interior. 

The  uterus  was  rather  small  and  firm.  Its  neck  was  conical,  and 
its  mouth  small  and  perfectly  circular.  The  cavity  of  the  organ 
contained  a  moderate  quantity  of  transparent  mucus,  slightly  tinged 
with  red.  A  part  of  its  internal  surface  was  rather  vascular,  but  it 
was  everywhere  smooth  and  firm,  and  of  its  natural  consistency. 


CORPUS  LUTEUM  OF  MENSTRUATION.         39 

The  right  ovary  was  one  and  a  half  inches  in  length,  and  of  the  ordi- 
nary yellowish-Tfhite  colour.  Its  surface  showed  several  shallow,  bluish 
cicatrices,  none  of  which  had  a  very  recent  appearance.  The  ovary 
contained  four  old  corpora  lutca,  the  largest  of  which  was  three-six- 
teenths of  an  inch  in  diameter,  and  entirely  similar  to  that  described 
in  the  preceding  observation,  except  for  being  smaller.  (Plate  II.  Fig. 
1.)  It  consisted  of  a  delicate,  flattened,  thin,  yellowish-white  wall, 
destitute  of  vessels,  and  enclosing  a  thin  fibrinous  coagulum,  which  was 
still  somewhat  coloured  with  blood.  Traces  of  a  convoluted  arrange- 
ment of  the  yellow  wall  were  quite  evident  on  close  inspection.  It 
was  neither  lined  nor  surrounded  by  any  membrane  that  could  be 
demonstrated,  but  was  immediately  in  contact  with  the  fibrinous  clot 
internally,  and  externally  appeared  closely  connected  with  the  ova- 
rian tissue. 

The  remaining  yellow  bodies  in  the  ovaries  were  smaller,  but 
otherwise  similar.  The  left  ovary  also  contained  one,  very  small. 
Both  ovaries  contained  many  Graafian  vesicles,  varying  in  size  from 
a  quarter  of  an  inch  or  less  to  three-eighths  of  an  inch  in  diameter. 

Both  oviducts  were  free  and  pervious  throughout.  They  con- 
tained a  moderate  quantity  of  thick,  whitish,  opake  fluid,  like  that 
met  with  in  Observation  I.     There  was  nothing  else  remarkable. 

From  the  foregoing  observations  we  can  deduce  a  more  or  less 
complete  history  of  the  corpus  luteum.  In  the  first  place,  it  is  cer- 
tain that,  in  connection  with  the  appearance  of  the  menstrual  period, 
a  Graafian  vesicle  arrives  at  maturity,  protrudes  from  the  surface  of 
the  ovary,  ruptures,  and  becomes  filled  with  blood.  Sometimes  this 
process  takes  place  in  each  ovary  at  the  same  period.  It  will  even 
hereafter  be  seen  that  two  vesicles  may  become  ruptured  simulta- 
neously in  the  same  ovary.  During  the  final  enlargement  of  the 
vesicle,  and  its  protrusion  from  the  ovarian  surface,  it  strongly  dis- 
tends the  albugineous  coat,  the  fibres  of  which  become  separated  and 
pushed  aside  to  such  a  degree  that  this  tunic  is  at  last  wanting  over 
a  spot  of  considerable  size  ;  and  the  vesicle  is  covered,  at  its  most 
prominent  part,  by  peritoneum  alone  ;  so  that,  at  the  time  of  the 
rupture,  it  is  only  the  peritoneal  coat  which  becomes  lacerated. 

The  precise  period,  during  the  catamenial  flow,  at  which  this  rup- 
ture takes  place,  does  not  seem,  as  yet,  to  be  definitely  ascertained. 
The  inherent  difficulty  of  making  these  observations  in  the  human 
subject,  and  the  rarity  of  opportunities  for  examining  the  ovaries  of 
healthy  women,  who  have  died  by  violence  or  after  a  rapid  illness, 


40  PRIZE    ESSAY. 

oppose  great  obstacles  to  our  arriving  at  a  correct  conclusion  on  this 
subject.  The  difficulty,  too,  of  estimating  the  influence  which  even 
a  short  illness  may  have  had  on  the  exact  period  of  rupture  is  so 
great,  that  many  further  observations  will  be  necessary,  in  order  to 
determine  with  certainty  so  nice  a  point.  Perhaps  this  period  is 
not,  even  in  the  ordinary  course  of  nature,  invariable  ;  and  if  we 
are  to  rely  on  such  information  as  we  already  possess,  this  would 
seem  to  be  the  most  probable  supposition.  Bischoff,*  Pouchet,t  and 
Raciborski|  all  agree  that  the  ovum  is  discharged  regularly,  only 
at  the  termination  of  the  menstrual  period,  and  this  opinion  is  cer- 
tainly sustained  by  Observations  VIII.  and  IX.  of  the  present  paper. 
Dr.  Robert  Lee§  also  relates  the  case  of  a  woman  who  died  "  while 
menstruating."  The  uterus  and  oviducts  were  lined  with  menstrual 
fluid,  and  on  one  ovary  was  a  large,  projecting,  Graafian  vesicle, 
having  over  it  an  abrasion  of  the  peritoneum.  On  the  other  hand, 
there  are  not  wanting  abundant  observations  of  Graafian  vesicles 
ruptured  during  the  menstrual  flow.  Such  an  observation  by 
Cruikshank,  recorded  in  the  Philosophical  Transactions,  1797,  has 
already  been  alluded  to.  Dr.  Lee||  gives  an  instance  of  a  Graafian 
vesicle  filled  with  blood,  death  having  taken  place  during  menstrua- 
tion, and  cites  other  similar  ones  from  Gendrin.  Bischoff^  states 
that  he  has  opened  the  bodies  of  four  females,  dead  suddenly  during 
menstruation.  Three  of  them  presented,  in  one  of  the  ovaries,  a 
vesicle  burst  and  filled  with  blood  ;  in  the  fourth,  there  was  remarked 
only  a  vesicle  not  yet  ruptured.  It  would  therefore  appear  that 
the  rupture  takes  place  sometimes  earlier  and  sometimes  later,  but 
that  it  always  has  an  intimate  relation  with  the  appearance  of  the 
catamenia. 

Another  remarkable  variation  in  the  appearance  of  the  vesicle  at 
this  period  depends  upon  its  larger  or  smaller  size  at  the  time  of  rup- 
ture, and  the  greater  or  smaller  quantity  of  blood  effused.  In  Ob- 
servation I.,  this  quantity  was  very  moderate,  as  may  be  seen  by 
reference  to  the  drawing.  In  Observation  III.,  it  Avas  much  larger; 
and  in  Observation  II.,  it  was  so  excessive  as  to  be  estimated  at  about 
one  ounce.  This  variation  may  probably  be  explained  by  the  differ- 
ence in  the  age  of  the  subjects,  and  in  the  condition  of  the  vascular 
system  generally,  whether  of  full  health,  of  plethora,  or  of  deficiency 
of  vascular  action.     It  also  depends,  without  doubt,  to  a  certain  ex- 

•  Op.  cit.,  p.  G2.  t  IljiJ-  P-  244.  {  Ibul.  p.  414. 

§  London  Med.  Gazette,  Nov.  5th,  1S4-2.  ||   Ibid. 

TT  Op.  cit.,  p.  50. 


CORPUS  LUTEUM  OF  MENSTRUATION.  41 

tent,  on  the  greater  or  less  activity  of  the  uterine  organs  in  particu- 
lar. Whatever  may  be  its  cause,  it  is,  perhaps,  not  more  remarka- 
ble than  the  differences  which  are  observed  in  the  size  of  the  ovaries 
themselves,  or  of  the  other  internal  organs.  It  will  hereafter  be 
seen,  in  another  division  of  this  paper,  that  the  size  of  the  vesicles, 
even  in  the  same  ovary,  is  not  always  the  same  at  the  period  of  their 
full  development,  those  which  are  matured  and  ruptured  not  always 
being  the  largest. 

Another  point  which  still  remains  somewhat  doubtful  relates  to 
the  period  at  which  the  hemorrhage  takes  place ;  whether  it  occurs 
before  or  after  the  time  of  rupture.  From  some  of  the  accompany- 
ing observations,  it  would  seem  probable  that  it  succeeds  to,  and  is  a 
consequence  of,  the  bursting  of  the  vesicle ;  since  we  have  seen  the 
vesicle,  at  a  late  period,  very  large  and  prominent,  with  its  contents 
still  clear  and  unmixed  with  blood.  Pouchet,*  however,  states  that 
the  ovum  is  pushed  from  the  bottom  of  the  vesicle  toward  the  surface 
by  a  gradual  hemorrhage  beneath  its  inner  membrane  (membrana 
granulosa) ;  and  that  the  vesicle  is,  in  this  way,  already  filled  Avith 
blood,  before  the  final  rupture  takes  place.  This  matter  must  be 
considered  as  still  uncertain.  Pouchet's  opinion  may,  no  doubt,  re- 
ceive support  from  some  observations  in  which  the  vesicle  has  been 
found  filled  with  blood  without  presenting  any  lesion  of  its  peritoneal 
coat.  It  must,  however,  be  remarked  that,  though  the  albugineous 
tunic  remains  for  a  long  time  deficient  at  the  spot  where  the  protru- 
sion of  the  vesicle  took  place,  yet  the  peritoneal  coat  is  very  rapidly 
reproduced ;  consequently,  no  perforation  might  be  visible  in  this 
membrane,  only  a  very  short  time  after  the  occurrence  of  the  rupture. 

The  rupture  of  a  Graafian  vesicle,  with  hemorrhagic  effusion  into 
its  cavity,  as  accompaniments  of  menstruation,  have  been  recognized 
by  some  writers,  who  are,  nevertheless,  unwilling  to  acknowledge 
that  an  ovum  is  at  the  same  time  discharged.  Dr.  Robert  Leef  con- 
siders it  probable  that  "  all  the  phenomena  of  menstruation  depend 
on,  or  are  connected  with,  some  peculiar  changes  in  the  Graafian 
vesicles,  in  consequence  of  which  an  opening  is  formed  in  their  peri- 
toneal and  proper  coats."  Notwithstanding  this,  he  denies  explicitly 
that  any  ovum  passes  from  the  ovarium  during  menstruation,  but  ap- 
pears to  consider  this  process,  when  it  does  occur,  as  excited  by  the 
stimulus  of  the  seminal  fluid.     Dr.  PattersonJ  entertains  a  similar 

•  Page  138.  f  Cyclop.  Pract.  Med.  iii.  4 J 4. 

J  Edinburgh  Med.  and  Surg.  Journal.  Jan.  iS40. 

4 


42 


PRIZE    ESSAY. 


opinion,  except  that  he  does  not  think  the  rupture  of  the  vesicle  at 
the  time  of  menstruation  a  constant,  but  only  an  occasional  occur- 
rence. This,  indeed,  is  a  matter  in  regard  to  which  we  must  be  con- 
tent, at  present,  to  rely  on  other  evidences  than  direct  observation ; 
for  I  am  not  aware  that  any  one  has  yet  seen,  in  the  human  female, 
an  unimpregnated  ovum  in  the  oviduct,  and  recently  discharged  from 
a  vesicle.  It  appears,  however,  contrary  to  all  known  physiological 
analogies  to  suppose  that  the  vesicles  should  be  ruptured  for  any 
other  purpose  than  that  of  discharging  their  contents.  It  is  conceded 
on  all  hands  that  the  human  ovum,  as  well  as  that  of  the  lower  ani- 
mals, exists  in  the  vesicle  previously  to  impregnation.  Thus  in  a 
young  girl,  ten  years  of  age,  dead  at  the  Female  Orphan  Asylum, 
January  9th,  1851,  of  perforation  of  the  stomach,  I  was  able  to 
discover  three  ova  in  one  ovary,  and  one  in  the  other.  No  doubt 
many  more  might  have  been  found,  but  that  the  vesicles  were  very 
friable,  and  many  became  ruptured  in  the  process  of  separating  them 
from  the  ovary.  The  vesicles,  containing  the  ova  above  mentioned, 
were  all  in  an  inactive  condition,  not  at  all  prominent,  but  situated 
entirely  beneath  the  albugineous  tunic. 

The  regular  tumefaction,  also,  and  rupture  of  the  vesicle  take 
place  in  both  the  human  species  and  the  lower  animals  in  a  manner 
entirely  analogous  ;  and  since  we  know  from  direct  observation  that, 
in  the  latter,  this  process  terminates  by  the  discharge  of  an  ovum,  it 
is  certainly  unreasonable  to  suppose  that  it  should  have  any  other 
object  in  the  former. 

Shortly  after  the  rupture  of  the 
fig.  6.  vesicle,  the  formation  of  the  corpus 

luteum  commences.  In  order,  how- 
ever, to  understand  distinctly  the 
manner  in  which  this  body  is  pro- 
duced, it  will  be  necessary  to  recall 
the  anatomical  relations  of  the  ve- 
sicle and  its  neighbouring  tissues. 
The  Graafian  vesicle,  in  its  ordinary 
quiescent  condition,  consists  of  a 
simple  globular  sac,  filled  with  a 
transparent,  albuminous  fluid.  It 
is  not  very  closely  connected  with 

Cell-like  bodies  of  the  mernbrana  granu-     ^^^  ^^^^j^^  substancC,  and  by  a  little 
lofsa.     (Each  division  of  the   scale  is  .  ,  . 

1-iooth  of  a  millimetre,  or  about  .0004th    manipulation  Can  bc  removed  entire ; 
of  an  inch.)  whcn  it  appears  as  a  smooth,  dia- 


CORPUS  LUTEUM  OP  MENSTRUATION.         43 

phanous  cyst,  usually  with  several  distinct  blood-vessels  ramifying 
over  its  surface.  It  is  said  to  be  lined  by  an  inner  membrane, 
the  memhrana  granulosa,  composed  of  minute,  granular,  cell-like 
bodies,  similar  to  those  Avhich,  collected  in  a  more  compact  mass 
round  the  ovum,  constitute  the  proligerous  disc.  These  bodies  are 
of  a  flattened  form,  and  nearly  circular  in  outline  Avhen  isolated, 
but  when  crowded  together  they  are  compressed  into  more  or  less 
angular  forms.  They  have  altogether  the  appearance  of  cell-nuclei 
rather  than  of  cells,  and  frequently  exhibit  a  very  distinct  nucleolus. 
They  are  undoubtedly  to  be  regarded  as  a  kind  of  epithelium,  lining 
the  serous  surface  of  the  Graafian  vesicle. 

The  membrana  granulosa,  however,  is  so  exceedingly  delicate  that 
it  is  very  easily  broken  up,  and  detached  from  the  internal  surface 
of  the  vesicle  by  the  necessary  manipulations ;  so  that,  in  ordinary 
dissections,  it  is  seen  only  as  a  collection  of  soft,  whitish,  membran- 
ous flocculi,  which  give  to  the  fluid  of  the  vesicle  an  appearance  of 
turbidity.  External  to  the  vesicle  are  a  number  of  irregular  vascu- 
lar laminae  of  cellular  substance,  which  can  only  be  raised  in  strips 
and  fragments,  varying  in  size  and  thickness.  These  cellular  layers 
have  sometimes  been  described  as  a  third  tunic  of  the  Graafian  vesi- 
cle, membrana  cellulosa  (membrane  celluleuse,  Pouchet) ;  but  they 
appear  rather  to  belong  to  the  tissue  of  the  ovary,  and  to  form  a  sort 
of  nidus,  or  bed  for  the  reception  of  the  vesicle. 

When  the  ovum  is  expelled,  the  proligerous  disc,  and  probably 
a  considerable  portion  of  the  membrana  granulosa,  are  expelled  with 
it.  The  proper  membrane  of  the  vesicle  then  begins  to  become 
hypertrophied ;  the  hypertrophy  consisting  in  a  peculiar  growth  of 
soft,  yellowish,  friable  substance,  which  takes  place  most  abundantly 
at  the  deepest  part  of  the  vesicle,  and  becomes  thinner  and  thinner 
as  we  approach  the  vicinity  of  the  cicatrix.  As  this  new  growth 
proceeds,  the  membrane  of  the  vesicle  becomes,  at  the  same  time, 
folded  upon  itself  in  all  directions,  so  as  to  present  innumerable  con- 
volutions and  anfractuosities,  which  give  a  radiated  appearance  to 
its  cut  surface.  This  peculiar  arrangement  seems  to  be  a  necessary 
consequence  of  the  increased  nutrition  of  the  membrane,  which  is, 
at  the  same  time,  confined  nearly  within  its  original  limits.  We  see 
the  same  thing  take  place  in  other  tissues  of  the  body  under  similar 
circumstances,  as  in  varicose  veins,  enlarged  ureters,  &c.  The  gray 
substance  of  the  brain,  during  the  first  five  months  of  foetal  life,  pre- 
sents a  smooth  surface,  without  any  trace  of  convolutions.  As  it 
afterward   increases  rapidly  in  extent,  the  cranial   cavity,  at  the 


44  PRIZE    ESSAY. 

same  time,  not  enlarging  In  proportion,  it  becomes  necessarily  folded 
upon  itself,  in  order  to  accommodate  its  increased  bulk  to  a  propor- 
tionally smaller  cavity.  The  valvulse  conniventes  of  the  small  intes- 
tine are  another  example  of  the  same  thing.  These  are  not  present 
during  the  greater  part  of  foetal  life,  the  mucous  membrane  being 
then  of  the  same  length  as  the  muscular  coat.  But,  as  it  afterward 
grows  more  rapidly  than  the  latter,  it  is  thrown  into  folds  which 
project  into  the  cavity  of  the  intestine.  It  is  the  same  process  which 
gives  rise  to  the  formation  of  the  corpus  luteum.  At  the  same  time 
that  the  hypertrophy  of  the  vesicular  membrane  proceeds,  the  blood 
eifused  within  its  cavity  also  undergoes  an  alteration.  Its  fluid  part 
is  absorbed,  and  afterward  the  coagulum  loses  by  degrees  its  colour- 
ing matter,  becoming  paler  and  paler,  in  proportion  to  the  time  which 
has  elapsed  since  the  rupture  of  the  vesicle.  The  vascularity  of  the 
neighbouring  parts  also  increases,  or,  at  least,  does  not  diminish, 
and  at  the  end  of  about  three  weeks  from  the  termination  of  the 
menstrual  period,  the  corpus  luteum  has  attained  its  maximum  of 
development.  Its  situation  is  then  marked  by  a  concentration  of 
vessels  on  the  surface  of  the  ovary,  and  by  a  globular  or  ovoid 
tumour,  about  the  size  of  the  end  of  the  finger,  which  causes  a  slight 
prominence  externally.  The  cicatrix  is  not  always  strongly  marked 
at  this  period,  and  may  consist  only  of  a  small,  bluish,  transparent 
spot,  indicating  a  separation  of  the  ruptured  peritoneum.  The 
tumour,  though  well  defined,  is  soft  and  yielding,  and  does  not  give 
to  the  touch  the  impression  of  a  very  highly  organized  body.  It 
does  not  now  contain  any  cavity,  properly  speaking;  but  its  centre 
is  occupied  by  the  solid,  semi-transparent,  gray,  or  greenish  coagu. 
lum,  more  or  less  mottled  with  red.  The  coagulum  is  in  immediate 
contact  with  the  inner  surface  of  the  yellow  wall,  but  can  be  sepa- 
rated from  it  by  a  little  manipulation,  as  the  two  have  no  organic 
connection.  Thewall  itself  still  forms  the  smallest  part  of  the  tumour, 
as  it  is  very  thin ;  not  more  than  one-eighth  of  an  inch  thick  at  its 
deepest  part,  when  allowed  to  remain  folded  up ;  but  if  the  convo- 
lutions are  unfolded,  it  is  seen  to  be,  in  reality,  much  thinner. 

The  point  of  rupture  of  the  vesicle  is  still  very  well  marked  on  a 
section  of  the  corpus  luteum,  provided  the  incision  be  made  accurately 
through  the  external  cicatrix  ;  for  at  that  spot  the  yellow  wall  ter- 
minates, and  the  central  coagulum  is  in  immediate  relation  with  the 
peritoneal  coat.  If  a  horizontal  section  be  made,  and  the  coagulum 
removed  from  over  the  point  of  rupture,  the  sinuosities  of  the  yellow 
wall  may  also  be  seen  radiating  from  it  as  a  centre. 


CORPUS  LUTEUM  OF  MENSTRUATION. 


45 


Fig.  7. 


Cells  from  the  wall  of  the  larger  corpus 
luteum  in  PI.  I.  Fig.  3  (same  scale). 


The  new  growth  or  deposit  of  yellow  matter,  when  examined  under 
the  microscope,  is  seen  to  consist  of  an  abundance  of  peculiar,  irregu- 
larly-shaped, granular  cells,  varying  in  size,  and  sometimes  enclosing 
minute,  opaline,  yellowish  globules, 
like  oil.  The  contour  of  the  cell- 
wall  can,  in  most  cases,  be  com- 
pletely traced  throughout ;  but,  in 
some  instances,  it  is  indistinct  at 
certain  parts  of  the  circumference. 
There  are  also  to  be  seen,  in  the 
field  of  the  microscope,  a  few  oil- 
globules,  similar  to  those  in  the  in- 
terior of  the  cells;  but  for  the  most 
part  of  larger  size.  The  cells  are 
rendered  paler  by  acetic  acid,  and 
their  (oil}^)  granules  and  globules 
become  more  distinct,  but  no  proper 
nucleus  is  visible. 

Dr.  Frank  Reuaud*  has  given  an  excellent  description  of  these 
cells.  He  is  disposed,  however,  to  regard  the  oil-globules  as  the 
"  nuclei"  of  the  cells,  whereas  they  do  not  have  at  all  the  appearance 
characteristic  of  ordinary  nuclei,  but  seem  to  be  rather  a  production 
of  the  cell  itself.  Indeed,  the  oil-globules  evidently  increase  in  quan- 
tity in  proportion  as  the  cells  become  atrophied  and  disappear. 

According  to  the  present  observations,  the  yellow  matter  is  essen- 
tially a  growth  of  the  proper  membrane  of  the  Graafian  vesicle. 
Much  difference  of  opinion,  however,  has  prevailed  among  writers 
with  regard  to  this  point,  some  asserting,  as  above,  that  the  new 
growth  consists  in  a  hypertrophy  of  the  outer  membrane  (Knox, 
Pouchet),  others  that  it  is  a  development  of  the  inner  membrane  (De 
Baer),  others  that  it  is  deposited  between  the  two  (Montgomery), 
and  others  that  it  is  external  to  both  (Lee).  A  part  of  this  discre- 
pancy, no  doubt,  arises  from  confusion  and  misunderstanding  as  to 
what  membranes  are  designated  by  the  terms  "inner"  and  "outer." 
Dr.  Montgomery,  for  instance, f  could  never  have  spoken  of  the 
inner  coat  of  the  Graafian  vesicle  as  a  "  strong  white  cyst,"  if,  under 
the  name  of  the  "inner  coat,''  he  had  intended  to  designate  the 
membrana  granulosa.     Some  writers,  indeed,  recognize  the  cellular 


•  London  and  Edinburgh  Monthly  Journal  of  Medical  Science,  August,  1845. 
f  Op.  cit.  p.  226. 


46  PRIZE    ESSAY. 

laminae,  already  spoken  of,  lying  external  to  the  outer  membrane, 
as  a  proper  tunic  of  the  vesicle.  In  reality,  they  cannot  be  so  con- 
sidered ;  and  when  we  take  into  view  the  exceedingly  friable  nature 
of  the  "membrana  granulosa,"  it  appears  most  correct  to  describe, 
with  Raciborski,  only  one  proper  membrane  of  the  Graafian  vesicle, 
the  "ovisac"  of  Barry,  the  '■^  vesicule  ovulifere"  of  Pouchet. 

This  is  the  membrane,  which,  by  its  development  and  consequent 
folding  up,  forms  the  corpus  luteum.  That  the  yellow  wall  is  not 
lined  by  any  second  membrane,  I  have  made  certain  by  frequent  ob- 
servations. At  the  same  time,  it  must  be  remarked  that,  after  a 
longer  period  of  time,  the  enclosed  coagulum,  flattened  and  com- 
pressed, and  deprived  by  absorption  of  all  its  colouring  matter,  may 
present  a  deceptive  resemblance  to  a  true  membrane  ;  particularly 
as  at  advanced  periods,  and  in  the  corpus  luteum  of  pregnancy,  it 
becomes  more  closely  adherent  to  the  yellow  wall.  Dr.  Robert  Lee, 
in  his  Lectures  on  Midwifery,  published  in  the  London  Medical  G-a- 
zette,  even  gives  two  drawings  of  corpora  lutea  (of  pregnancy),  in 
which,  in  accordance  with  his  ideas,  there  are  demonstrated  two  distinct 
membranes  within  the  yellow  wall.  These  must  certainly  have  been 
formed  accidentally,  by  an  artificial  separation  of  the  central  coagu- 
lum into  laminae.  In  the  corpus  luteum  of  menstruation,  and  also 
in  that  of  pregnancy,  if  of  recent  date,  it  is  easy  to  demonstrate  the 
entire  absence  of  any  real  lining  membrane. 

Externally  the  corpus  luteum  is  invested  with  an  extremely  thin, 
transparent,  vascular  membrane,  to  which  it  is  intimately  connected, 
and  which  sends  prolongations  between  the  convolutions  of  the  yel- 
low matter.  This  layer,  indeed,  seems  to  form  rather  a  memhra^ious 
surface  than  a  distinct  tunic,  and  cannot  be  stripped  off  without 
bringing  with  it  torn  fragments  of  the  yellow  matter.  It  is,  in  fact, 
the  outer  surface,  merely  of  the  membrane  of  the  vesicle,  the  new 
growth  having  sprouted  from  its  internal  aspect,  toward  the  cavity 
of  the  vesicle.  External  to  this,  are  the  vascular  layers  of  cellular 
tissue,  which  have  already  been  described  as  surrounding  the  Graafian 
vesicle,  and  forming  a  nidus  for  it  in  the  ovarian  tissue,  previous  to 
the  time  of  its  complete  development. 

The  substance  of  the  corpus  luteum  is  not  vascular,  though  minute 
red  vessels  may  often  bo  seen,  apparently  running  into  the  yellow 
matter,  from  without  inward.  A  close  examination,  however,  shows 
these  vessels  to  exist  only  in  the  interstices  of  the  convolutions,  where 
they  have  penetrated  from  the  vascular  network  on  the  external  sur- 
face of  the  body. 


CORPUS  LUTEUM  OF  MENSTRUATION.         47 

It  lias  been  already  shown  that  the  development  of  the  yellow 
matter  commences  soon  after  the  rupture  of  the  vesicle  has  taken 
place.  The  strange  theory  regarding  these  bodies,  entertained  by 
Sir  Everard  Home,  and  afterwards  adopted  by  N^grier,  viz.,  that 
the  yellow  matter  is  deposited  before  the  rupture,  that  it  is  intended 
to  aflford  nutrition  to  the  ovum,  and  that,  consequently,  corpora  lutea 
are  only  one  stage  of  the  ascending  development  of  the  Graafian 
vesicle,  must  certainly  be  regarded  as  entirely  erroneous.  It  is  dis- 
proved in  the  most  positive  manner  by  several  of  the  accompanying 
observations.  We  see,  for  instance,  in  one  case  the  Graafian  vesicle 
large,  prominent  on  the  surface  of  the  ovary,  distended  with  serosity, 
and  apparently  on  the  point  of  rupture,  while  the  vesicular  membrane 
has,  as  yet,  undergone  no  change. 

Secondly,  we  have  Graafian  vesicles,  freshly  ruptured  and  filled 
with  blood,  with  the  vesicular  membrane  equally  unaltered  as  before. 
Thirdly,  beyond  this  period  we  have  corpora  lutea  in  all  stages  of 
retrogression  ;  but  wherever  the  deposit  of  yellow  matter  has  taken 
place,  the  vesicle  contains  blood,  and  has  evidently  been  ruptured. 
The  only  exception  to  this  rule  is  in  the  case  of  some  very  small 
corpora  lutea,  which  have  already  been  long  subjected  to  the  pro- 
cess of  absorption,  and  in  which  it  is  therefore  difficult  to  recognize 
the  remains  of  the  coagulum. 

It  is  not,  however,  necessary  to  rely  entirely  on  the  accompanying 
observations,  to  disprove  the  theory  above  alluded  to.  N^grier  himself 
refers  to  the  cases  "  communicated  to  him  by  Dr.  Ollivier  D'Angers," 
of  two  women  who  committed  suicide  during  a  menstrual  period.  In 
each  case,  one  ovary  presented  a  bloody  ruptured  vesicle  ("  rupture 
vesiculaire  saignante"),  containing  a  soft  and  recent  coagulum.  But 
nothing  is  mentioned,  in  either  case,  about  any  alteration  of  the  in- 
ner surface  of  the  vesicle.  In  the  three  cases  by  Bischoff,  already 
referred  to,  of  recently  ruptured  vesicles,  there  is  no  mention  made 
of  any  yellow  deposit  being  visible.  There  is  also  another  exceed- 
ingly interesting  case  of  the  rupture  of  a  vesicle  during  menstruation 
reported  by  Dr.  Myddleton  Michel  in  the  Charleston,  S.  0.  31edical 
Journal  (quoted  in  the  Amerhcan  Journal  of  3Iedical  Sciences,  July 
1848).  It  was  that  of  a  woman  who  was  executed  for  murder.  She 
had  been  imprisoned  several  weeks  previously  to  the  execution,  and 
had  undoubtedly  been  deprived  of  sexual  intercourse.  At  the  ex- 
amination, the  OS  uteri  was  found  "open,  tumefied,  and  dripping  with 
blood,"  and  its  inner  surface  coated  with  blood,  and  "  congested"  at 
its  upper  part.     The  right  ovary  contained  a  number  of  vesicles  in 


48  PRIZE    ESSAY. 

process  of  development,  containing  clear  fluid.  The  left  liad  a  rup- 
tured vesicle  on  its  anterior  surface,  with  its  orifice  partially  closed 
by  a  bloody  coagulum.  The  membrana  granulosa  (examined  by  the 
microscope)  also  protruded  through  the  opening.  The  cavity  of  the 
Graafian  vesicle  was  filled  with  coagulated  blood.  Its  tunic  was  very 
vascular,  and  "  had  not  yet  hegim  to  fold,  to  form  the  corpus  luteum." 
The  precise  period  during  menstruation  at  which  death  took  place 
in  this  instance  was  not  ascertained  with  certainty. 

Ndgrier,  however,*  gives  one  observation  on  this  point  which  is  not 
very  easily  explained.  He  describes  very  accurately  a  recent  corpus 
luteum  of  menstruation  found  by  him  in  an  ovary  which,  as  he  says, 
did  not  present  on  its  surface  "  any  trace  of  rupture."  With  regard 
to  this,  I  can  only  say  that  I  have  not  met  with  a  similar  case,  and 
that  it  is  contrary  to  the  experience  of  most  other  observers. 

After  the  end  of  the  third  week  from  the  close  of  menstruation, 
the  corpus  luteum  passes  into  a  retrograde  condition.  It  diminishes 
in  size ;  and  the  fibrinous  coagulum  becomes  absorbed,  and  loses  still 
farther  its  colouring  matter.  The  diminution  of  the  size  of  the  body 
takes  place  more  particularly  in  a  certain  direction  ;  so  that,  from 
having  a  globular  or  ovoid  form,  it  becomes  collapsed  and  flattened, 
either  laterally  or  from  within  outward.  In  consequence  of  this 
flattening,  the  corpus  luteum  at  this  period  may  appear  to  vary  con- 
siderably in  size,  according  as  the  section  has  been  made  in  the  plane 
of  its  compressed  surfaces  or  perpendicularly  to  them.  Thus,  in  Ob- 
servations IX.  and  X.,  both  of  which  give  specimens  of  corpora 
lutea  four  weeks  after  menstruation,  the  apparent  size  of  these  bodies 
is  very  diff"erent.  But,  if  we  consider  that  one  has  evidently  been 
cut  across,  while  the  other  was  probably  divided  in  the  plane  of  its 
compression,  the  diff'erence  will  not  appear  so  striking.  Still,  it  is 
undoubtedly  the  case  that  these  bodies  do  not,  in  all  instances,  be- 
come atrophied  with  the  same  rapidity,  and  that  more  or  less  varia- 
tion is  apparent  in  this,  as  in  most  other  physiological  operations  of 
nature.  It  is  certain,  too,  that  the  effused  coagulum  does  not  always 
lose  its  colour  with  the  same  readiness ;  since,  in  some  of  the  draw- 
ings which  represent  corpora  lutea  of  four  weeks  or  over,  the  clot  is 
even  redder  than  in  Observation  VI,  where  it  is  represented  at  the 
termination  of  the  third  week. 

The  colour  of  the  yellow  wall,  however,  during  the  early  part  of 
the  retrograde  stage,  instead  of  fading  like  that  of  the   fibrinous 

•  Op.  cit.  page  22. 


CORPUS  LUTEUM  OF  MENSTRUATION. 


49 


Fig.  8. 


clot,  becomes  more  strongly  marked.  From  the  dull  yellowisli-red 
hue,  similar  to  that  of  recent  lymph,  -which  it  had  at  first,  it  assumes 
a  brighter  and  more  decided  yellow,  and  contrasts,  therefore,  more 
strongly  with  the  neighbouring  tissues.  This  yellow  hue  of  the  cor- 
pus luteum  has  been  attributed  by  various  writers  to  an  alteration 
in  the  colouring  matter  of  the  efi'used  blood,  similar  to  that  which 
takes  place  in  the  neighbourhood  of  old  apoplectic  clots.  Pouchet* 
so  considers  it,  and  Raciborskif  entertains  the  same  opinion.  A 
microscopic  examination  of  the  corpus  luteum  at  this  period,  how- 
ever, demonstrates  that  this  colour  depends  principally  on  the  pre- 
sence of  oil,  which  is  seen  in  larger  or  smaller  globules,  and  having 
the  same  yellowish  tinge  which  is  presented  by  the  whole  body  when 
viewed  by  the  naked  eye.  The  oil-globules,  in  fact,  which,  at  an 
earlier  period,  were  seen  in  small  numbers  and  of  minute  size,  and 
for  the  most  part  enclosed  within 
the  irregular  granulated  cells,  have 
now  become  large  and  abundant,  so 
as  to  occupy  nearly  the  whole  field, 
while  the  cells  themselves  have  dis- 
appeared, or  are  with  difficulty  dis- 
tinguishable. Everything  leads  us 
to  believe  that  the  cells  are  a  forma- 
tion destined  to  produce  the  oil,  as 
a  gland  its  secretion  ;  and  that,  when 
they  have  accomplished  this  purpose, 
they  disappear  and  are  replaced  by 
the  ordinary  fibrous  tissue  of  the 
ovarian  stroma. 

As  the  corpus  luteum  diminishes  in  size,  the  yellow  matter  becomes 
softer  and  more  friable,  and  shows  less  distinctly  the  markings  of  its 
convolutions.  At  the  same  time,  it  is  more  intimately  connected 
with  the  neighbouring  tissues,  so  that  it  can  be  less  readily  enu- 
cleated from  the  ovary.  The  central  coagulum  is  no  longer  any- 
thing more  than  a  faint,  whitish,  stellate  cicatrix ;  while  the  yellow 
matter  itself  often  also  assumes  a  stellated,  triangular,  or  other 
similar  form,  and  pursues  constantly  a  retrograde  course,  which  ter- 
minates finally  in  its  obliteration.  When  the  corpus  luteum,  how- 
ever, has  reached  this  advanced  stage  of  retrogression,  it  appears 
to  become  comparatively  stationary,  and  its  alterations  proceed  less 


Oil-globules  from  the  smaller  corpus 
luteum  in  PI.  I.  Fig.  3  (same  scale). 


•  Page  14G. 


t  Page  437. 


50  PRIZE    ESSAY. 

rapidly  than  at  an  earlier  period  ;  so  that  it  may  remain  for  some 
months  afterward  as  a  minute,  faint,  obsolete,  yellow  spot,  imbedded 
in  the  ovarian  substance.  In  the  case  of  Mrs.  A.,  Observation  IX., 
seven  of  these  obsolete  yellow  bodies  were  distinguishable,  besides 
that  resulting  from  the  last  rupture  of  a  vesicle,  the  oldest  of  which 
probably  dated  from  a  period  of  eight  months.  In  general  terms, 
then,  it  may  be  stated  that  a  period  of  six  to  eight  weeks  is  sufficient 
to  reduce  the  corpus  luteum  of  menstruation  to  an  insignificant,  soft, 
thin,  compressed  sac,  measuring  less  than  a  quarter  of  an  inch  in 
its  longest  diameter,  and  with  its  opposite  walls  nearly  or  quite  in 
contact ;  but  that  after  this  time  it  remains  more  quiescent,  and  that 
a  period  of  eight  months  sometimes  elapses  before  its  final  and  com- 
plete destruction. 

There  is  good  reason  to  believe  that,  in  connection  with  the  pro- 
cesses of  menstruation,  a  peculiar  change  takes  place  in  the  internal 
surface  of  the  uterus,  which  results  in  the  formation  and  separation 
of  a  decidual  membrane.  Pouchet,*  indeed,  considers  the  regular 
monthly  formation  and  discharge  of  a  decidua  as  satisfactorily  estab- 
lished. Dr.  Robert  Leef  states  that  the  uterine  decidua  is  a  thing 
of  frequent  occurrence  in  unmarried  females,  and  does  not  consider 
its  presence  as  the  slightest  evidence  of  the  existence  of  pregnancy. 
He  cites  also  Drs.  Baillie  and  Blundell  in  support  of  the  same 
views.  The  last-mentioned  writers,  however,  are  not  disposed  to 
consider  the  formation  of  a  decidua,  unconnected  with  pregnancy, 
as  a  regular  physiological  phenomenon,  but  rather  as  an  occasional 
appearance,  dependent  perhaps  on  difficulty  of  menstruation.  In 
reality,  however,  it  is  very  probably  a  process  which  recurs  spon- 
taneously somewhere  about  each  menstrual  period. 

The  mucous  membrane  of  the  uterus,  in  its  ordinary  inactive 
condition,  presents  a  smooth,  pale  surface,  of  considerable  firmness. 
It  does  not  have  the  appearance  of  a  distinct  membrane,  but  rather 
of  a  membranous  surface,  owing  to  the  softness  of  its  structure, 
and  its  intimate  connection  with  the  subjacent  uterine  tissue.  It 
is  only  occasionally  that  we  can  succeed  in  raising  with  the  forceps 
very  thin,  delicate  strips,  which  in  reality  appear  to  be  rather 
portions  of  epithelium  than  of  the  mucous  membrane  itself.  At 
this  time,  it  is  difficult  for  the  eye  to  distinguish  any  peculiarities  of 
structure,  but  when,  at  certain  periods,  the  membrane  has  become 
swollen  and  hypertrophied,  numerous,  very  minute,  whitish,  wavy 

•  Page  249.  f  London  Med.  Gazette,  vol.  xxxi.  p.  412. 


CORPUS  LUTEUM  OF  MENSTRUATION.         51 

or  zigzag  lines  may  be  seen  running  from  the  inner  part  of  the  sub- 
stance of  the  uterine  parietes,  and  terminating  on  its  free  surface. 
In  the  ewe,  these  lines  are  much  more  distinctly  seen,  particularly 
at  those  spots  where  the  cotyledons  are  afterward  to  be  developed. 
These  appearances,  together  with  the  remaining  parts  of  the  uterine 
mucous  membrane,  are  described  at  length  by  C.  B.  Reichert  in  the 
first  number  of  Muller's  Archiv  for  1848.*  According  to  him, 
these  whitish  lines  arc  the  glandular  ducts  or  tubuli  of  the  uterine 
mucous  membrane  ;  which  open  upon  its  free  surface,  and  are  lined 
by  a  continuation  of  its  epithelium.  After  conception,  this  portion 
of  the  membrane  becomes  much  hypertrophied  ;  the  tubuli  are 
lengthened,  and  their  orifices,  destined  afterwards  to  receive  the 
villi  of  the  chorion,  become  visible  on  the  surface.  The  membrane 
increases  also  in  vascularity,  and  becomes  soft  and  spongy,  and 
finishes  by  being  transformed  into  the  decidua  vera,  and  at  last 
expelled  from  the  uterus.  This  change  has  also  been  recognized  by 
other  writers  as  taking  place  after  conception,  and  Dr.  Carpenterf 
even  states  that  it  "occurs  whether  the  ovum  reach  the  uterus  or 
not,  it  being  probably  invariable  in  cases  of  extra-uterine  preg- 
nancy." 

The  preceding  observations,  however,  make  it  probable  that  this 
formation  accompanies  the  regular  processes  of  menstruation,  whe- 
ther the  ovum  be  fecundated  or  not.  It  will  be  noticed  that,  in  all 
the  foregoing  cases  except  four,  viz.,  Obs.  I.,  II.,  VIII.,  and  XI.,  there 
existed  more  or  less  softening  and  sponginess  of  the  uterine  mucous 
membrane.  In  two  of  these  four  cases,  Obs.  I.  and  VIII.,  a  decidual 
membrane  had  just  been  separated,  or  was  nearly  so,  and  was  found 
in  the  cavity  of  the  uterus.  In  Obs.  II.,  it  had  very  probably  been 
expelled  from  the  organ,  and  in  Obs.  XI.  all  the  functions  of  the 
generative  system  had  been  suspended  for  more  than  two  months  ; 
a  circumstance  which  accounts  satisfactorily  for  the  absence  of  any 
alteration  in  the  mucous  surface  of  the  uterus.  In  Obs.  X.,  in  which 
the  softening  existed,  but  only  to  a  slight  degree,  these  functions 
had  been  arrested  for  a  period  of  about  four  weeks. 

The  separation  and  expulsion  of  the  decidual  membrane  seem  to 
take  place  about  the  time  of  the  rupture  of  the  Graafian  vesicle,  that 
is  to  say,  toward  the  termination  of  the  menstrual  period.    After  this 

*  Ueber  die  Biklung  der  liinfalligen  Hilute  der  Gebiir  mutter,  und  deren  VerhiLltniss 
zur  placenta  uterina. 

t  Principles  of  Human  Physiology,  p.  579. 


52  PRIZE    ESSAY. 

separation,  the  internal  surface  of  the  uterus  is  left  firm,  pale,  and 
smooth.  It  soon  recommences,  however,  to  become  hypertrophied, 
and  in  the  course  of  a  short  time  it  presents  a  soft,  velvety,  shaggy 
alteration,  extending  to  the  depth  of  three-sixteenths  or  a  quarter 
of  an  inch,  and  showing  very  distinctly  the  whitish,  wavy,  or  zigzag 
tubuli,  intermixed  with  numerous  fine  blood-vessels,  extending  to- 
ward the  free  surface  of  the  membrane.  The  decidual  membrane 
is,  in  this  way,  in  process  of  preparation  during  the  descent  of  the 
ovum  through  the  tubes,  and  while  it  is  yet  unprepared  to  make  any 
vascular  connection  with  the  walls  of  the  uterus. 


PAET   IT. 
COHrUS  LUTEUM  OF  PREGNANCY. 


OBSERVATION  XII. 

Corpus  luteum  of  pregnancy  about  the  end  of  the  second  month. 

R.  D.  L.,  a  married  woman,  twenty-nine  years  of  age,  died  in  Boston 
on  the  28th  of  April,  1851,  under  the  following  circumstances.  She 
sat  down  to  the  tea-table  with  her  family,  in  perfect  health,  on  the 
evening  of  Friday  the  25th.  While  they  were  at  tea,  a  notorious 
quack,  a  Thompsonian,  who  had  already  been  at  the  house  in  the 
early  part  of  the  afternoon,  returned ;  and  Mrs.  L.  left  the  table, 
and  went  up  stairs  to  her  chamber  in  company  Avith  him.  She  was 
known  to  have  previously  resorted  to  this  man  for  the  purpose  of 
procuring  abortion. 

After  remaining  for  some  time  in  the  chamber  with  Mrs.  L.,  the 
Thompsonian  left  the  house,  but  Mrs.  L.  kept  her  bed,  and,  in  fact, 
never  left  it  from  that  time  till  her  death,  which  took  place  on  the 
Monday  following.  On  Saturday  she  was  quite  ill,  and  on  Sunday 
so  much  worse  that  her  friends  insisted  on  discharging  the  Thomp- 
sonian and  calling  in  other  advice.  Dr.  M.  S.  Perry  was  accord- 
ingly sent  for.  On  arriving,  he  found  Mrs.  L.  exceedingly  collapsed, 
and  presenting  marked  signs  of  peritonitis.  There  was  so  much 
disturbance  of  the  intellectual  faculties  that  the  patient  was  unable 
to  give  any  account  of  herself ;  but  her  appearance  and  symptoms 
were  so  characteristic  that  Dr.  P.  at  once  concluded  that  abortion 
had  been  produced.  He  sent  for  Dr.  C.  E.  Buckingham,  who  in 
the  evening  visited  the  patient  with  him,  and  concurred  entirely 
in  his  diagnosis.  There  was  no  reaction  of  the  system  at  any  time 
after  Dr.  P.  was  first  called,  and  the  patient  died  on  Monday  about 
11  A.  M. 

The  friends  of  the  woman  were  convinced  that  abortion  had  been 
produced;  and  there  were  various  other  suspicious  circumstances, 


54  PRIZE    ESSAY. 

besides  those  above  related,  which  were  testified  to  at  the  inquest. 
Owing  to  the  absence  of  her  husband,  there  were  reasons  why  Mrs. 
L.  should  wish  to  have  the  fact  of  her  pregnancy  concealed.  The 
verdict  of  the  coroner's  jury  was  that  she  came  to  her  death  in  con- 
sequence of  an  abortion  produced  by  the  above-mentioned  Thomp- 
sonian. 

At  the  autopsy,  which  was  performed  on  the  day  succeeding 
death,  the  body  generally  presented  an  appearance  of  perfect  deve- 
lopment and  full  health.  There  were  no  marks  of  disease  except 
such  as  were  quite  recent.  These  consisted  in  a  moderate  peritoneal 
effusion,  and  in  some  inflammation  of  the  mucous  membrane  of  the 
stomach,  oesophagus,  and  larynx,  rendering  it  probable  that  the 
patient  had  swallowed  some  irritating  drug,  a  portion  of  which  had 
found  its  way  into  the  air-passages. 

The  uterus  was  much  enlarged.  It  measured  four  and  a  half 
inches  in  length,  two  and  three-quarters  in  width,  and  one  and  three- 
quarters  in  its  antero-posterior  diameter.  Its  increased  thickness 
was  caused  by  the  bulging  of  its  posterior  face,  which  had  a  nearly 
globular  form,  while  the  anterior  face  was  hardly  more  rounded  than 
in  the  natural  condition.  There  was  some  bright  vascularity  about 
the  posterior  face  and  fundus  of  the  uterus,  but  not  of  an  inflamma- 
tory appearance.     The  Fallopian  tubes  were  also  very  vascular. 

On  cutting  into  the  uterus  from  behind,  its  cavity  was  found  to  be 
entirely  occupied  by  the  reddened  and  hypertrophied  mucous  mem- 
brane, and  a  fibrinous-looking  granular  substance  entangled  with  it. 
The  walls  of  the  uterus  were  of  their  natural  colour  and  consist- 
ency, so  far  as  regarded  their  muscular  substance,  but  the  mucous 
membrane  was  exceedingly  hypertrophied  and  reddened,  presenting 
all  the  appearances  met  with  in  the  ordinary  formation  of  decidua, 
in  connection  with  menstruation,  but  in  an  infinitely  greater  degree. 
The  decidua  was  continuous  with  the  muscular  substance,  and  could 
not  be  very  readily  separated  from  it ;  though  the  line  of  division 
between  the  two  was  very  well  marked,  owing  to  their  difi"erence  in 
colour;  the  latter  being  pale,  the  former  dark  red.  The  decidua 
was  composed  of  a  multitude  of  fine  softish  fibres,  easily  seen  by  the 
naked  eye,  which  lay  in  a  parallel  position,  and  projected  into  the 
cavity  of  the  uterus  ;  hanging  from  its  internal  surface  like  the  hair 
from  a  bear  skin.  On  the  posterior  wall  and  a  little  to  the  right 
side,  the  decidua  was  much  thicker  than  elsewhere,  and  was  here 
continued  into  a  moderately  firm,  stringy,  fibrinous-looking  mass, 
which  enclosed  a  multitude  of  minute  granules.     This  mass  hung 


CORPUS  LUTEUM  OF  PREGNANCY. 


55 


down  freely  into  tlie  cavity  of  the  cervix,  and  before  opening  the 
uterus,  miglit  be  made  to  protrude  from  the  os  externum  by  com- 
pressing the  uterus  in  the  hand.  Its  lower  extremity  "was  soft, 
sloughy,  and  grayish  ;  but  its  upper  part  still  firm,  red,  and  fresh- 
looking. 

Examined  by  the  microscope,  it  was  evidently  composed  of  the 
villi  of  the  chorion,  a  part 

of  which  had  remained,  after  Fig.  9. 

the  expulsion  of  the  ovum, 
still  entangled  with  the  mu- 
cous membrane  of  the  uterus. 
The  villi  presented  somewhat 
the  appearance  of  membran- 
ous tubes,  of  various  sizes, 
terminating  by  a  single  or 
double  cul-de-sac,  and  some- . 
times  having  lateral  dilata- 
tions or  processes.  With 
high  powers,  an  appearance 
was  seen  as  if  the  villi  con- 
tained minute  cells,  or  as  if 
the  tubes  were  lined  with  a 
delicate  epithelium. 

There  was  no  blood  in  the  uterine  cavity,  except  at  one  spot  on 
its  posterior  aspect,  near  the  fundus,  where  there  was  a  roundish 
cavity  about  the  size  of  a  pea,  in  the  substance  of  the  chorion  and 
decidua,  which  was  filled  with  very  dark,  but  fresh-looking  blood. 

There  was  nowhere  in  the  uterus  any  appearance  of  a  defined 
placental  attachment. 

The  right  ovary,  an  inch  and  a  quarter  in  length,  was  yellowish 
white  externally,  with  several  slender,  old  adhesions  to  its  surface. 
It  contained  no  corpora  lutea,  with  the  exception  of  a  single  yellow 
'point,  too  small  to  show  any  definite  structure.  There  were  a  num- 
ber of  Graafian  vesicles  beneath  the  albugineous  tunic,  varying  in 
size  from  one-eighth  of  an  inch  diameter  downward;  but  none  pro- 
jecting on  the  surface  of  the  ovary,  or  at  all  visible  from  the  outside. 

The  left  ovary,  considerably  thicker  than  the  right,  showed  on  its 
posterior  surface  a  slightly  depressed  spot,  over  which  was  attached 
a  long,  slender,  organized,  bridle-shaped  adhesion,  and  in  the  neigh- 
bourhood of  which  a  yellow  colour  showed  through  from  beneath  the 
fibrous  coat.     On  makinjr  a  lonffitudinal  section  through  the  de- 


Villi  of  the  chorion. 


56  PRIZE    ESSAY. 

pressed  spot,  a  corpus  luteum  was  exposed,  measuring  seven- eighths 
of  an  inch  in  length  by  one-half  an  inch  in  depth.  It  consisted  of 
a  light-yellow,  thin,  convoluted  external  layer,  and  an  enclosed, 
colourless,  firm,  fibrinous  mass,  with  a  central  cavity  containing  a 
few  drops  of  limpid  fluid.  The  relations  of  the  central  coagulum, 
the  yellow  wall,  and  the  investing  membrane  were  the  same  as  in  all 
the  corpora  lutea  previously  observed.  (See  Plate  II.  Fig.  2.) 

This  ovary  contained  another  corpus  luteum,  situated  directly 
beneath  the  albugineous  tunic,  three-eighths  of  an  inch  long,  but 
very  narrow,  and  much  compressed,  the  yellow  matter  very  thin  and 
friable,  and  incapable  of  being  separated  whole  from  the  ovarian 
tissue.  The  walls  of  this  corpus  luteum  were  nearly  in  contact,  and 
its  contents  colourless. 

There  was  also  another  yellow  spot,  much  smaller  than  the  last, 
and  very  indistinct  in  structure,  but  which,  apparently,  was  also  an 
old  corpus  luteum  of  menstruation. 

The  left  ovary  contained  but  few  Graafian  vesicles  which  were 
visible,  and  those  of  very  small  size. 

Both  oviducts  contained  an  abundance  of  thick,  opake,  yellowish 
fluid,  consisting  mostly  of  ciliated  columnar  epithelium. 

The  period  of  pregnancy  in  this  case  was  estimated,  first,  from 
the  size  of  the  uterus;  and,  secondly,  from  the  fact  that  the  placenta 
had  as  yet  assumed  no  regular  shape,  while,  at  the  same  time,  its 
future  situation  was  sufficiently  well  marked  by  an  unusual  develop- 
ment of  the  villi  of  the  chorion  at  one  spot,  and  their  adhesion  to 
the  uterine  surface.  It  will  at  once  be  observed,  on  comparing  the 
corpus  luteum  in  this  case,  with  that  of  Obs.  X  (Pi.  I.  Fig.  5), 
how  great  is  the  diff"erence  between  them.  The  latter,  of  only  four 
weeks'  date,  is  already  considerably  advanced  in  the  process  of  atro- 
phy; while  the  former,  nearly  or  quite  twice  as  old,  has  still  retained 
all  its  activity,  and  is,  indeed,  increasing  in  size,  notwithstanding 
that  sufficient  time  has  elapsed  for  the  colouring  matter  of  the  coagu- 
lum to  be  completely  absorbed.  The  difi"erence  will  be  still  more 
striking  if  we  compare  it  with  PI.  II.  Fig.  1,  in  which  the  corpus 
luteum  is  of  nearly  the  same  date  with  the  present. 


CORPUS  LUTEUM  OF  PREGNANCY.  57 

OBSERVATION    XIII. 

Corpus  luteum  of  pregnancy  about  the  termination  of  the  fourth  month. 

.4 

E.  S.,  a  fine,  healthy-looking  gu'l,  twcntj-one  years  of  age,  died 
at  the  house  of  Mr.  A.,  in  Boston,  on  Wednesday  the  7th  May,  1851. 
She  had  been  employed  in  Mr.  A.'s  family  as  a  seamstress  since  the 
previous  winter,  living  in  the  house  during  the  week,  but  going  away 
on  Saturdays  to  her  cousin's  in  Pleasant  Street,  and  returning  to 
Mr.  A.'s  on  Monday  morning.  She  had  been  for  some  months  re- 
ceiving the  attentions  of  a  young  man  who  was  reputed  to  be  en- 
gaged to  her.  None  of  her  friends  suspected  anything  to  be  wrong 
"with  her  until  Monday  evening,  May  5th,  when  her  cousin,  with 
whom  she  had  been  spending  Sunday  as  usual,  perceived  the  odour 
of  tansy  in  the  room  which  she  had  occupied;  whereupon  it  occurred 
to  her  that  the  girl  might  have  become  pregnant,  and  used  the  drug 
for  the  purpose  of  producing  abortion. 

On  Tuesday  she  was  in  good  spirits,  and  engaged  in  her  ordinary 
employment  throughout  the  day.  She  took  leave  of  the  family  as 
usual,  and  went  up  stairs  to  her  room  about  half  past  nine  o'clock, 
P.  M.  Soon  afterward,  the  family  were  alarmed  by  a  scream,  and 
on  going  up  stairs,  found  the  girl  stretched  on  the  floor  by  the  side 
of  her  bed,  insensible,  and  in  violent  convulsions.  Dr.  Samuel 
Morrill  was  immediately  called,  and  I  also  saw  her  soon  after. 
There  Avas  a  strong  odour  of  tansy  in  her  breath,  and,  on  searching 
the  room,  a  two  ounce  phial  was  found  in  the  pocket  of  one  of  the 
girl's  dresses,  still  containing  5v  of  the  oil  of  tansy.  The  mug  from 
which  she  had  drunk  the  oil  was  also  found,  with  several  drops  re- 
maining on  the  bottom.  It  was  subsequently  ascertained  that  she 
had  purchased  the  phial  full  of  oil  of  tansy  a  few  days  previously. 
She  remained  totally  insensible,  with  violent  convulsions  at  short 
intervals,  till  a  quarter  past  2,  A.M.,  when  she  died. 

At  the  autopsy,  made  May  7th,  ten  hours  after  death,  there  were 
found  some  marks  of  congestion  of  the  brain.  The  stomach  and 
upper  part  of  the  small  intestine  contained  an  abundance  of  oil  of 
tansy.  On  first  opening  the  body,  the  odour  of  tansy  was  powerfully 
exhaled  from  the  cavity  of  the  peritoneum,  from  the  interior  of  the 
heart,  and  from  the  cut  surface  of  the  pectoral  muscles. 

The  uterus  was  enlarged  so  that  its  upper  edge  was  two  inches  and 
three-quarters  above  the  level  of  the  symphysis  pubis.  It  was  also 
5 


68  PRIZE    ESSAY. 

slightly  inclined  to  tlie  left,  and  lay  in  a  somewhat  diagonal  position, 
so  that  its  left  edge  was  considerably  nearer  the  abdominal  parietes 
than  the  right.  Its  external  surface  was  generally  yellowish-gray, 
mottled,  in  some  situations,  with  large  bundles  of  red  vessels,  but 
without  any  inflammatory  appearance.  The  vascularity  of  the 
oviducts  was  also  quite  moderate. 

The  uterus,  unopened,  weighed  one  pound.  Its  length,  including 
the  neck,  was  six  inches  and  a  quarter.  Length  of  neck,  measured 
internally,  was  one  inch  and  three-eighths.  Breadth  of  uterus,  four 
inches  and  one-eighth.  The  amnion  and  chorion  were  in  contact. 
The  placenta  was  perfectly  formed,  circular  in  shape,  three  inches 
in  diameter.  The  cord  was  five  inches  long,  very  slightly  twisted 
from  left  to  right.     It  was  well  covered  with  gelatinous  matter. 

The  umbilical  vesicle  still  existed  as  a  delicate,  flattened,  pellucid 
sac,  three-sixteenths  of  an  inch  in  diameter,  situated  beneath  the 
amnion,  on  the  internal  surface  of  the  placenta,  at  a  distance  of 
three-quarters  of  an  inch  from  the  insertion  of  the  cord.  In  its 
centre  there  was  a  yellowish,  granular,  opake  spot.  A  single  fine 
red  vessel  ran  from  the  insertion  of  the  cord  to  the  vesicle,  and  then 
branched  over  it  in  minute  ramifications. 

The  foetus,  a  female,  was  nearly  six  inches  in  length.  Its  surface 
was  smooth,  without  sebaceous  covering  or  hair.  Skin  transparent, 
and  everywhere  marked  by  an  elegant  vascular  network.  It  showed 
also  very  distinctly  the  numerous  hair  follicles  as  minute,  opake, 
white  specks.  The  muscles  were  contracted,  and  the  limbs  rigid. 
Umbilicus  situated  a  little  above  pubis.  Middle  point  of  body 
situated  nearly  midway  between  umbilicus  and  lower  end  of  sternum. 
Head  voluminous.  Mouth  widely  open.  Tongue  well  formed.  Eye- 
lids in  contact ;  not  to  be  separated  without  forcibly  tearing  epider- 
mis. Pupils  widely  dilated.  Nostrils  open.  Pupillary  membrane 
complete.  Fingers  and  toes  completely  formed,  and  nails  distinctly 
visible. 

External  genital  organs  distinct.  Clitoris  projecting  far  beyond 
nymphte. 

The  liver  came  down  nearly  as  low  as  pubis.  The  kidneys  and 
STipra-renal  capsules  were  equal  in  size :  kidneys  pale  and  lobulatcd ; 
capsules  dark  red. 

The  large  intestine  was  destitute  of  either  transverse  or  longitudinal 
bands. 

Ossification  of  the  ribs  was  sufficiently  well  advanced.     Consider- 


CORPUS  LUTEUM  OF  PREGNANCY.  59 

able  ossification  of  ilium;  none  of  ischium  or  pubis;  none  of  cal- 
caneum  ;  none  of  ossicula  auditus. 

The  foetus  was,  therefore,  estimated  to  be  about  four  months  old. 

The  left  ovary,  which  hung  doAvn  a  little  lower  than  the  right, 
had,  on  its  outer  extremity,  a  small  conical  prominence,  where  the 
fibrous  coat  was  wanting,  and  its  place  supplied  by  peritoneum  alone. 
There  was  a  slight  appearance  here  of  a  cicatrix,  visible  only  on 
close  inspection.  No  unusual  vascularity  here  or  at  any  other  part 
of  the  ovary.  Beneath  this  prominence,  the  corpus  luteum  could 
be  felt  through  the  ovarian  tissue  tolerably  firm  and  well  defined, 
and  having  the  form  of  a  sphere,  compressed  laterally,  much  like 
that  of  the  crystalline  lens.  On  dividing  the  ovary  longitudinally 
through  the  prominence,  the  corpus  luteum  presented  a  nearly  cir- 
cular section,  seven-eighths  of  an  inch  in  its  long,  and  three-fourths 
of  an  inch  in  its  short,  diameter.  (Plate  II.  Fig.  3.)  The  convo- 
luted wall  was  of  a  dull  yellow,  considerably  less  brilliant  than  in 
the  preceding  case,  and  decidedly  thicker,  as  it  measured,  at  its 
deepest  part,  a  little  over  three-sixteenths  of  an  inch  in  thickness. 
The  space  enclosed  by  the  yellow  wall  was  occupied  by  a  fibrinous, 
colourless,  reticulated  coagulum,  which  possessed  a  few  minute 
vessels.  This  central  coagulum  was  much  compressed  laterally ; 
for,  though  it  presented  a  cut  surface  of  about  half  an  inch  in  diame- 
ter, it  had  hardly  more  than  one  line  in  thickness.  There  was  no 
cavity  nor  fluid  anywhere. 

Both  ovaries  were  carefully  divided  in  every  direction,  but  only 
one  other  body  was  found  bearing  any  resemblance  to  a  corpus 
luteum,  and  that  was  so  small  and  imperfect  as  to  be  hardly  recog- 
nizable. There  were  many  Graafian  vesicles  in  the  interior  of  each 
ovary,  varying  in  diameter  from  three-sixteenths  of  an  inch  down- 
ward, but  none  at  all  prominent  on  the  surface.  Both  ovaries  were 
quite  healthy. 

On  comparing  this  case  with  that  detailed  in  Obs.  XII.,  it  will 
be  seen  that  the  corpus  luteum  has  increased  in  development.  The 
convoluted  wall  has  become  thicker,  and  has  begun  to  lose  its  bril- 
liant tinge;  the  fibrinous  coagulum  has  become  more  compressed 
and  absorbed,  and  the  central  cavity,  if  any  had  existed,  is  com- 
pletely obliterated.  At  the  same  time,  it  is  interesting  to  observe 
that  the  old  corpora  lutea  of  menstruation,  of  which  three  existed 
in  the  preceding  case,  have  now  been  reduced  to  one.  They  have, 
in  fact,  successively  disappeared,  while  the  corpus  luteum  last  formed 
has  continued  its  development  under  the  influence  of  pregnancy. 


60  PRIZE    ESSAY. 


OBSERVATION    XIV. 

Death  at  the  termination  of  the  seventh  month  of  pregnancy — One  ovary  de- 
stroyed by  disease,  the  other  containing  tvro  corpora  lutea — A  blighted  ovum 
in  the  corresponding  oviduct,  and  a  seven  months'  foetus  in  the  uterus. 

M.  M.,  a  married  woman,  thirty-two  years  of  age,  stout  and  full- 
blooded,  died  suddenly  at  Lowell,  on  Tuesday,  December  17th,  1850. 
She  was  the  mother  of  four  children,  the  youngest  of  whom  was 
two  years  and  a  half  old.  At  the  time  of  her  death,  she  considered 
herself  to  be  seven  months  advanced  in  pregnancy,  expecting  to  be 
confined  in  the  middle  of  February,  1851. 

Her  husband,  who  performed  duty  as  a  night-watchman,  left  his 
wife  on  Monday,  the  16th,  at  11  P.  M.,  apparently  in  perfect  health. 
She  had  then  retired  to  bed,  but  talked  to  him,  just  before  he  left, 
in  her  ordinary  cheerful  manner.  He  passed  his  watch,  and  returned 
home  next  morning  at  5  A.  M.,  and,  on  going  up  to  his  wife's  cham- 
ber, found  her  lying  on  the  floor,  warm  but  quite  dead.  There  were 
no  appearances  of  any  disturbance  in  the  room.  The  husband  im- 
mediately gave  the  alarm,  and  a  physician  was  called;  but  there 
were  no  signs  of  life. 

At  the  autopsy,  next  day,  there  were  no  marks  of  violence  to  be 
seen,  with  the  exception  of  some  slight  bruises  on  the  right  knee, 
and  the  right  side  of  the  head  and  face,  which  slie  might  easily  have 
received  in  falling.  All  the  internal  organs  were  in  a  state  of  marked 
congestion,  and  the  blood  was  everywhere  fluid.  No  other  lesion, 
however,  was  discoverable  anywhere,  Avith  the  exception  of  a  change 
in  one  of  the  ovaries,  and  one  or  two  serous  cysts  in  the  liver,  which 
could  not,  in  any  way,  account  for  death. 

The  uterus,  of  a  natural  grayish-yellow,  and  dull-red  colour,  was 
in  the  median  line.  Its  upper  edge  was  half  an  inch  above  the 
level  of  the  umbilicus  (subject  lying  on  the  back).  It  was  covered 
for  the  upper  third  of  its  anterior  surface  by  the  transverse  colon 
and  great  omentum.  It  measured  eleven  and  one-fourth  inches  in 
its  long  diameter,  and  eight  and  one-eighth  inches  in  its  transverse. 
It  weighed,  unopened,  a  little  less  than  seven  pounds.  The  thick- 
ness of  the  uterine  parietes,  at  its  fundus,  was  three-eighths  of  an 
inch.  The  cervix  uteri,  two  inches  in  length,  was  plugged  by  a  mass 
of  colourless,  tenacious  secretion.  Its  lower  extremity  was  lax  and 
soft,  admitting  the  little  finger  with  ease;   but  its  upper  part  was 


CORPUS  LUTEUM  OF  PREGNANCY.  61 

contracted  and  impassable.  The  os  uteri  and  upper  portion  of  the 
vagina  •svere  of  a  purplish  colour;  the  rest  of  the  vagina  being  of  a 
light  rosy  hue. 

The  chorion  and  amnion  were  in  contact ;  and  the  amniotic  fluid 
something  over  one  pint  in  amount.  The  placenta  was  situated  at 
the  lower  and  anterior  part  of  the  uterus,  a  short  distance  from  the 
uterine  orifice  of  the  cervix.  The  cord  measured  nineteen  inches 
in  length.  The  foetus,  perfectly  formed,  weighed,  together  with  one 
inch  of  the  cord,  three  pounds.  It  had  no  cadaveric  rigidity.  Its 
skin  was  of  a  reddish  colour,  and  had  a  thin  covering  of  sebace- 
ous matter.  There  was  rather  an  abundance  of  dark  hair  on  the 
scalp.  The  nails  projected,  in  many  instances,  quite  to  the  ends  of 
the  fingers;  in  others,  not  so  far.  They  were  all  very  soft.  The 
eyelids  were  in  contact,  but  not  adherent.  There  was  some  opacity 
of  each  cornea.  Both  testicles  had  descended  into  the  scrotum,  but 
could  be  pushed  back  nearly  into  the  cavity  of  the  abdomen. 

There  was  no  mark  of  violence  or  disease  about  either  the  uterus 
or  foetus. 

The  right  ovary,  situated  immediately  beneath  the  liver,  was 
almost  entirely  converted  into  an  encysted  tumour,  nearly  globular 
in  shape,  with  thin,  tough,  membranous  walls,  and  about  the  size 
of  the  foetal  head.  It  weighed,  unopened,  a  little  less  than  one 
pound.  It  contained  a  mass  of  yellowish-white  fatty  matter,  re- 
sembling lard  in  appearance  and  consistency.  There  were  also  a 
few  drachms  of  thickish,  dingy-yellow,  oily  fluid,  with  a  fetid  odour. 
Intermixed  with  the  lardaceous  matter,  was  a  large  quantity  of  long 
and  short,  dark-coloured  hair;  most  of  it,  like  the  fatty  matter, 
entirely  unconnected  with  the  internal  surface  of  the  cyst.  This 
surface  was,  for  the  most  part,  smooth  and  glistening,  like  a  serous 
surface;  but  at  one  spot  it  assumed  the  appearance  of  skin,  becoming 
whitish-opake,  and  provided  with  follicles,  from  which  short  hairs 
projected  into  the  cavity  of  the  cyst.  At  one  spot  underneath  this 
scalp-likc  surface,  was  a  considerable  mass,  like  adipose  tissue,  and 
beneath  that  an  irregularly-shaped  piece  of  bone,  hard,  white,  and 
surrounded  by  periosteum.  There  were  two  other,  much  smaller 
cysts,  filled  with  transparent,  gelatinous  fluid,  and  a  little  of  what 
appeared  to  be  the  remains  of  genuine  ovarian  stroma ;  but  there 
were  no  normal  Graafian  vesicles,  nor  any  other  appearance  natural 
to  the  organ. 

There  were  no  appearances  of  old  or  recent  inflammatory  action 
anywhere  about  the  ovary,  but  all  the  surfaces   externally  were 


62  PRIZE    ESSAY. 

smooth  and  normal ;  only  the  oviduct  and  its  fimbriated  extremity 
were  of  a  lively  red  colour. 

The  left  ovary,  one  inch  and  a  half  in  length,  was  pale,  and  of 
natural  appearance  externally.  On  one  of  its  lateral  surfaces  there 
was  a  small  oval-shaped  spot,  where  the  albugineous  tunic  was  Avant- 
ing,  and  which  showed  a  faint  yellowish  coloration.  (Plate  II.  Fig. 
4.)  The  centre  of  this  spot  showed  a  faint  linear  cicatrix,  very 
slightly  depressed,  from  which  radiated  a  few  red  and  purple  vessels. 
The  corpus  luteum,  situated  immediately  underneath,  caused  a  slight 
prominence  externally,  and  could  be  readily  felt  as  a  roundish,  well- 
defined  tumour,  not  hard,  but  still  having  considerable  resistance. 
Its  section,  of  an  oval  form,  showed  the  body  to  be  somewhat  com- 
pressed from  within  outward.  It  was  half  an  inch  in  length,  and  a 
quarter  of  an  inch  in  depth.  It  consisted  of  a  central,  whitish, 
radiated  cicatrix,  surrounded  by  a  thick,  softish,  elastic,  and  strongly 
convoluted  wall.  The  relative  proportion  of  these  parts  is  exhibited 
in  the  drawing.  (Plate  11.  Fig.  5.)  No  distinct  communication  of 
the  central  cicatrix  with  the  exterior  could  be  detected;  probably 
owing  to  the  abundant  growth  of  the  convolutions,  which  had  re- 
duced this  communication  to  a  linear  cicatrix,  easily  missed  in  making 
a  section  of  the  ovary.  The  thickness  of  the  wall  was  considerably 
less  on  its  superficial  than  on  its  deep  aspect.  Its  colour  was  a 
faint  yellowish-white,  not  much  unlike  recent  lymph,  and  very  diff"er- 
ent  from  the  bright  yellow  hue  of  the  corpus  luteum  of  menstruation, 
at  an  advanced  period.  It  showed  an  abundance  of  fine  red  vessels 
converging  from  the  exterior,  which  had  at  first  the  appearance  of 
being  situated  in  the  substance  of  the  wall,  but  which,  on  close  in- 
spection, seemed  only  to  penetrate  the  interstices  of  the  convolutions. 
Externally,  the  corpus  luteum  was  invested  by  an  exceedingly  thin, 
transparent,  vascular  membrane,  to  which  it  was  intimately  attached, 
and  with  which  it  could  be  readily  separated  from  the  rest  of  the 
ovary;  but,  in  performing  the  separation,  several  irregular  strips  of 
cellular  tissue  were  raised  with  it. 

Near  the  other  extremity,  and  on  the  opposite  surface  of  the 
ovary,  was  another  spot  similar  to  that  already  described;  i.  e.,  a 
space  where  the  fibrous  tunic  was  wanting,  and  in  which  there  ex- 
isted a  faint  yellowish  coloration,  and  a  noticeable  concentration  of 
vessels.  Immediately  beneath,  was  a  second  corpus  luteum,  abso- 
lutely similar  to  the  first  except  in  being  a  little  smaller  as  the 
section  was  made,  i.  e.,  seven-sixteenths  of  an  inch  long,  by  a  quarter 
of  an  inch  deep.     The  central  cicatrix  here  had  a  verv  distinct 


CORPUS  LUTEUM  OF  PREGNANCY. 


63 


Fis.  10. 


Left  ovary  of  M.  M. — Second 
corpus  luteum. 


communication  Avith  the  exterior.     The  Avhole  appearance  of  this 
corpus  luteum  indicated  the  same  stage  of 
development  with  the  former. 

The  left  oviduct  Tvas  quite  free  and 
pervious  throughout.  On  cutting  it  open, 
there  Avas  found,  at  a  distance  of  three 
inches  from  its  fimbriated  extremity,  a 
soft,  greenish-yellow  mass,  about  the  size 
of  a  hazelnut.  Externally,  it  Avas  quite 
smooth  and  soft,  and  without  any  appear- 
ance of  organization ;  but  toward  its  cen- 
tre it  had  considerable  firmness  and  a 
more  ruddy  colour,  and  showed  some  fine 
red  vessels,  ramifying  in  its  substance. 
Altogether,  it  had  much  the  appearance 
of  a  slough  of  cellular  tissue,  which  had 
not  yet  become  quite  disorganized  and 
difiluent.  At  one  spot  it  had  distinct 
vascular  connections  with  the  internal  surface  of  the  oviduct;  but 
could  easily  be  separated,  leaving  some  shreds  of  the  slough-like 
material  adhering  to  the  spot.  There  was  no  particular  vascularity 
or  other  alteration  of  the  mucous  membrane  of  the  oviduct  in  its 
immediate  neighbourhood,  but  only  some  unevenness  of  surface  at  the 
point  where  the  tumour  had  adhered. 

There  were  absolutely  no  Graafian  vesicles  on  the  surface  of  the 
ovary,  but  several  were  situated  beneath  the  albugineous  tunic, 
along  the  free  edge  of  the  organ,  varying  in  size  from  an  eighth  of 
an  inch  in  diameter,  downward.  The  ovary  was  carefully  divided 
in  every  direction,  but  nothing  else  like  a  corpus  luteum  was  any- 
where to  be  met  with. 

It  will  immediately  be  seen  how  much  this  corpus  luteum  differs 
in  appearance  and  description  from  those  heretofore  delineated,  as 
existing  in  company  with  an  unimpregnated  uterus.  This  case  is 
particularly  interesting  from  the  fact  that  two  ova  had  evidently 
been  discharged  from  the  left  ovary  at  about  the  same  time,  and  had 
both  been  fecundated.  One,  however,  contracted  adhesions  to  the 
oviduct  and  became  blighted  after  a  very  short  period  of  develop- 
ment ;  while  the  other  proceeded  to  the  uterus,  and  underwent  the 
ordinary  changes  of  uterine  growth.  This  woman  had  evidently  a 
constitutional  tendency  to  arrest  the  progress  of  the  ova  through 
the  tubes,  since  very  much  the  same  thing  had  previously  happened 


64  PRIZE    ESSAY. 

on  the  right  side.  For  we  must  certainly  regard  these  encysted 
tumours  of  the  ovary,  containing  bones,  fat,  and  hair,  as  the  result 
of  degenerate  ova,  which  have  become  arrested  at  the  ovary,  either 
before  or  after  their  impregnation. 

This  case  also  makes  it  evident  that  it  is  not  any  particular  change 
in  the  ovum  itself,  which  gives  a  peculiar  character  to  the  corpus 
luteum  of  pregnancy,  but  the  condition  of  the  uterine  organs  gene- 
rally ;  for  we  have  here  two  perfect  corpora  lutea,  though  only  one 
of  the  ova  had  become  developed.  If  it  were  otherwise,  as  the 
ovum  became  blighted,  its  corresponding  corpus  luteum  would  have 
been  atrophied  simultaneously  with  it. 


OBSERVATION    XV. 

Corpus  luteum  of  pregnancy  in  the  eighth  month. 

C.  H.,  a  woman,  thirty  years  of  age,  evidently  advanced  in  preg- 
nancy, died  at  the  Cholera  Hospital  in  Boston,  August  8th,  1849, 
after  an  illness  of  fifteen  and  a  half  hours. 

The  uterus  came  up  nearly  to  the  level  of  the  umbilicus.  It  was 
pear-shaped,  and  inclined  to  the  right  side,  so  that  full  two-thirds  of 
the  organ  lay  to  the  right  of  the  median  line.  It  had  a  dull  reddish 
vascularity  on  its  external  surface.  The  fluctuation  of  the  liquor 
amnii  could  be  readily  felt  through  the  uterine  walls,  as  well  as  the 
head  and  limbs  of  the  foetus.  The  uterus  measured  nine  and  a  half 
inches  in  its  longitudinal  diameter,  and  six  and  a  half  in  its  trans- 
verse. The  thickness  of  its  walls,  divided  through  the  middle  of  its 
anterior  surface,  was  three-eighths  of  an  inch.  The  os  uteri  had  a 
rounded,  tumefied  appearance,  and  a  dark  purplish  colour.  The 
cavity  of  the  cervix  was  filled  Avith  tenacious  secretion.  The  attach- 
ment of  the  placenta  was  at  nearly  the  middle  part  of  the  anterior 
uterine  wall,  but  a  little  to  the  left  of  the  median  line.  It  was 
nearly  circular  in  shape,  and  five-eighths  of  an  inch  in  thickness. 
The  chorion  and  amnion  were  in  contact,  and  the  amniotic  fluid 
about  fourteen  ounces  in  amount.  The  cord  was  twenty-two  inches 
in  length. 

The  right  ovary,  one  inch  and  three-quarters  long,  contained  a 
corpus  luteum,  situated  at  one  extremity  of  the  organ.     This  body 


CORPUS  LUTEUM  OF  PREGNANCY. 


65 


11. 


was  irregularly  ovoid  in  shape,  measuring  nine-sixteenths  of  an 
inch  in  lenp^th,  and  half  an  inch  in  depth.  It  consisted  of  a  firm, 
yellowish-'wlntc,  -well-organized  looking  substance,  -which  showed  fine 
red  vessels  converging  towards  the  centre.  It  had  no  cavity,  but 
its  centre  was  occupied  by  an  irregularly  elongated,  firm,  opaline 
coagulum,  closely  connected  with  the  rest  of  the  body.  Externally, 
there  Avere  the  same  layers  of  cellular  tissue  previously  described. 

The  colour  of  this  body  was  a  much  less  decided  yellow  than  is 
often  seen  in  "false"  corpora  lutea.  It  differed  from  them  also  in 
several  other  respects,  as  follows  : — 

I.  Its  globular  form,  and  firm,  resisting  feel. 

II.  Its  organized  appearance  internally. 

III.  There  was,  on  the  surface  of  the  ovary,  at  a  spot  corresponding 
to  the  corpus  luteum,  a  well-defined,  strongly-depressed  cicatrix. 

The  ovary  also  contained  a  firm,  opake,  whitish  body,  in  the  situ- 
ation indicated  in  the  drawing,  much  smaller  than  the  corpus  luteum, 
and   not    exhibiting    any    of    its    peculiar 
structure;  apparently  a  morbid  growth. 

The  left  ovary  was  two  inches  in  length, 
but  very  slender  and  much  atrophied.  It 
contained  a  small,  globular,  whitish,  opake 
body,  like  that  mentioned  as  occurring  in 
the  right  ovary  (morbid).  There  was  no- 
thins;  else  remarkable  about  the  uterus  or 
appendages. 

The  foetus,  a  female,  measured  fourteen 
inches  in  length,  and  weighed,  with  one 
inch  of  the  cord  attached,  three  pounds 
five  and  a-half  ounces.  There  was  no  ca- 
daveric rigidity.  The  skin  was  of  a  rosy 
hue,  rather  thick  and  tough,  and  covered, 
over  a  great  part  of  its  surface,  with  fine, 

white,  short  hairs.  The  scalp  was  covered  with  fine  dark  hair,  a 
quarter  of  an  inch  long.  The  nails  reached  nearly,  but  not  quite, 
to  the  ends  of  the  fingers.  The  umbilicus  was  situated  an  inch 
above  the  pubis,  and  three-quarters  of  an  inch  below  the  middle 
point  of  the  body.  The  eyelids  were  in  contact,  but  easily  sepa- 
rated. There  was  slight  opacity  of  each  cornea.  There  was  no 
pupillary  membrane. 

The  foramen  of  Dotal  was  a  quarter  of  an  inch  in  diameter,  but 
could  be  completely  covered,  from  the  left  side,  by  its  valve.     The 


Corpus  luteum  of  pregnancy 
in  ihe  middle  of  the  eighth 
month. 


6Q  PRIZE    ESSAY. 

arterial  duct  appeared  like  the  continuation  of  the  pulmonary  trunk, 
•while  the  right  and  left  pulmonary  arteries  seemed  to  be  only  small 
branches. 

There  were  no  valvule  conniventes  in  the  small  intestine,  and 
the  large  intestine  was  quite  round  and  smooth,  unmarked  by  either 
transverse  or  longitudinal  bands.  It  was  distended  with  dark  green- 
ish meconium  from  the  ilco-coecal  valve  to  within  an  inch  of  the 
anus.  The  kidneys  were  lobulated  externally,  and  rather  more 
bulky  than  the  supra-renal  capsules;  but  the  length  of  the  two  bodies 
was  the  same,  viz.,  one  and  one-eighth  inch. 

There  Avere  three  points  of  ossification  in  the  sternum.  The  cal- 
caneum  had  one  point  of  ossification,  well  advanced ;  and  the  astra- 
galus also  one  point,  just  commenced.  The  axis  had  one  point  of 
ossification  in  its  body,  and  another  in  the  odontoid  process. 

The  foetus  was  therefore,  in  all  probability,  seven  months  and 
a-half  old. 


OBSERVATION    XVI. 

Corpus  luteum  at  the  termination  of  pregnancy. 

E.  S.,  a  healthy  woman,  about  twenty-seven  years  of  age,  a  pa- 
tient of  Dr.  Samuel  Cabot,  was  taken  with  labour  pains  on  Wednes- 
day, February  19th,  1851;  only  five  days  before  her  full  time, 
according  to  the  patient's  reckoning.  After  labour  had  continued 
eight  hours,  rupture  of  the  uterus  took  place,  and  the  woman  died 
five  days  afterward. 

The  uterus  and  ovaries  were  given  to  me  by  Dr.  Cabot. 

The  body  of  the  uterus  was  five  inches  and  a  half  long,  and  its 
anterior  wall  a  little  over  one  inch  in  thickness.  The  cervix  uteri 
was  two  and  one-eighth  inches  in  length,  and  thoroughly  dihated.  The 
OS  internum  was  distinctly  marked  by  a  slightly  projecting  ridge, 
viewed  internally,  at  the  lower  extremity  of  the  uterine  body.  The 
rupture  was  transverse,  three  and  a  half  inches  long,  and  situated 
just  at  the  junction  of  the  body  of  the  uterus  with  the  cervix.  The 
edges  of  the  rupture  were  everted,  and  retained  in  the  everted  posi- 
tion by  a  deposit  of  recent  lymph ;  which  was  also  abundant  all  over 
the  peritoneal  surface  of  the  uterus.    The  right  ovary  was  plentifully 


CORPUS  LUTEUM  OF  PREGNANCY. 


67 


12. 


covered  Avith  lymph,  but,  on  stripping  off  tliis  deposit,  the  cicatrix 
of  the  corpus  luteum  could  be 
readily  distinguished  on  the  free 
edge  of  the  organ.  Immediately 
beneath,  the  body  itself  was  indis- 
tinctly perceptible  to  the  touch. 

On  cutting  it  open,  the  corpus 
luteum  was  seen  to  be  of  an  indefi- 
nite, light-yellowish  hue,  but  little 
contrasted  with  the  remainder  of 
the  organ.  The  central  coagulum 
was  very  scanty,  having  been  re- 
duced to  a  thin  white  cicatrix. 

In  the  above  drawing,  the  walls 
of  the  yellow  body  are  shown  very 
much  folded  in,  at  one  spot.  This 
is  in  consequence  of  the  first  sec- 
tion, from  which  the  drawing  was 
taken,  not  having  been  made  di- 
rectly through  the  centre;  but  an- 
other section,  more  successfully  performed,  showed  its  whole  surface 
occupied  by  yellow  matter,  thrown  into  minute  folds. 

There  was  no  other  appearance  of  corpora  lutea  in  either  ovary, 
nor  any  prominent  Graafian  vesicles. 


Corpus  luteum  at  the  termination  of 
pregnancy. 


OBSERVATION    XVII. 


Corpus  hiteum  of  pregnancy  nine  ■weeks  after  delivery. 

A.  G.,  a  married  woman,  twenty-six  years  of  age,  died  in  Boston, 
Sept.  20th,  1850,  of  irritant  poisoning.  In  early  life  she  had  shown 
some  symptoms  of  insanity,  but  of  late  years  her  health  had  been 
good.  A  fortnight  previous  to  her  death,  she  had  lost  an  infant 
child,  seven  weeks  old,  and  since  that  time  had  been  much  depressed 
in  spirits,  and  had  not  had  her  usual  appetite,  but  had  not  been 
otherwise  indisposed.  She  left  her  home  soon  after  breakfast  on 
the  mornin";  of  the  20th,  and  in  the  afternoon  was  found  in  the  sta- 
tion  house  of  the  "Western  Railroad,  evidently  very  sick,  and  unable 


68  PRIZE    ESSAY. 

to  give  any  account  of  herself.  She  was  immediately  removed  to 
the  Massachusetts  General  Hospital,  where  she  arrived  at  half  past 
four  P.  M.  She  was  then  much  nauseated,  with  lividity  and  cool- 
ness of  the  skin,  swelling  of  the  lips,  and  a  very  rapid  and  feeble 
pulse.  She  could  neither  speak  nor  swallow.  She  rapidly  became 
more  and  more  collapsed  and  insensible,  and  died  in  a  little  less 
than  two  hours  after  her  entrance. 

At  the  autopsy,  next  day,  the  stomach  was  found  excessively  in- 
flamed. It  was  somewhat  contracted  and  collapsed,  and  contained 
six  ounces  of  a  dark  red,  bloody-looking  fluid,  which  was  thickened 
by  holding  in  suspension  a  large  amount  of  light  reddish  flakes,  like 
those  seen  in  the  discharges  of  dysentery.  The  parietes  of  the 
stomach  generally  were  exceedingly  thickened,  so  that  its  anterior 
wall,  near  the  pyloric  extremity,  measured  three-eighths  of  an  inch 
in  thickness,  and  about  the  cardiac  extremity  nearly  a  quarter  of  an 
inch.  This  abnormal  thickness  was  entirely  owing  to  infiltration  of 
the  submucous  cellular  tissue,  of  a  slight  reddish  tinge,  nearly  uni- 
form throu2;hout  the  organ.  The  mucous  and  muscular  coats  were 
unchanged  in  thickness. 

The  internal  surface  of  the  stomach  was  of  an  intense  purple  red 
throughout  the  middle  third  of  the  organ,  where  the  mucous  mem- 
brane was  thrown  into  numerous  transverse  and  longitudinal  folds. 
In  the  great  pouch  the  mucous  membrane  was  of  a  dark  slate  colour, 
and  had,  at  the  same  time,  a  finely  granulated  appearance,  owing  to 
its  surface  having  been  strongly  corrugated  and  thrown  into  minute 
folds,  of  an  opake  gray  colour.  There  Avas  also,  at  this  part,  much 
dark  purple  and  black  ecchymosis,  situated  in  the  substance  of  the 
mucous  membrane,  as  well  as  beneath  it.  There  was,  besides,  some 
redness  of  the  small  intestine,  and  much  submucous  infiltration  and 
ecchymosis  about  the  larynx  and  upper  part  of  the  trachea;  as  if 
some  of  the  poison  had  accidentally  found  its  way  into  the  air-pas- 
sages. There  were  no  other  morbid  appearances  of  importance. 
The  woman  was  known  to  have  had  corrosive  sublimate  in  her  pos- 
session previous  to  leaving  home. 

The  vagina  Avas  smeared,  at  its  upper  part,  with  a  little  leucor- 
rhoeal  secretion.  The  uterus,  much  reduced  in  size,  was  only  a  little 
larger  than  in  the  ordinary,  unimpregnated  state.  The  os  uteri  was 
transverse,  purple,  and  much  fissured.  The  internal  uterine  sur- 
face showed  considerable  dark-coloured  redness,  but  was  otherwise 
unaltered. 

Both  ovaries  showed  many  Graafian  vesicles  in  process  of  develop- 


CORPUS  LUTEUM  OF  PREGNANCY.  69 

ment,  but  no  sign  of  any  recent  rupture.  One  of  them  had  also  a 
very  small  and  ancient-looking  body,  situated  immediately  beneath 
a  depressed  cicatrix,  which  was  the  only  thing  like  a  corpus  luteum 
to  be  found  in  the  ovary.  The  colour  of  this  body  was  very  similar 
to  that  of  the  ovarian  tissue.  Its  section  was  slightly  oval,  about  a 
quarter  of  an  inch  in  diameter,  and  presented  an  opake,  whitish, 
central  mass,  external  to  which  traces  of  a  convoluted  structure 
were  visible  on  close  examination.  The  whole  aspect  of  the  body, 
however,  was  obsolete  and  inactive,  and  its  markings  quite  indistinct. 


OBSERVATION    XVIII. 

Corpus  hiteum  of  pregnancy  nine  months  and  a  half  after  delivery. 

C.  L.,  a  married  woman,  twenty-six  years  of  age,  a  patient  of 
Dr.  G.  N.  Thompson,  died  in  Boston,  June  24th,  1850.  She  was 
the  mother  of  three  children,  the  youngest  of  whom,  a  healthy  boy, 
was  nine  months  and  a  half  old.  The  patient  had  not  menstruated 
since  the  birth  of  this  last  child. 

She  was  confined  on  the  eighth  of  September,  1849,  without  any 
unusual  occurrence.  Two  or  three  weeks  after  delivery,  she  was 
attacked,  from  some  unknown  cause,  with  salivation,  followed  by 
great  irritability  of  the  bowels,  so  that  she  had  ten  or  twelve  dis- 
charges daily;  often  bloody  and  mucous  in  character.  These  symp- 
toms were  at  first  controlled  by  remedies ;  but  not  long  afterward 
the  irritability  of  the  bowels  again  returned,  her  strength  and 
flesh  failed,  and  the  skin  became  excessively  pallid.  She  improved 
again  under  tonic  treatment,  but  afterward  failed  a  third  time; 
anaemia,  emaciation,  weakness,  and  irritability  of  the  bowels  being 
the  most  prominent  symptoms.  She  had  also  a  moderate  cough, 
not  frequent  or  troublesome.  During  the  latter  part  of  her  life, 
the  discharges  from  the  bowels  were  not  bloody  nor  mucous,  but  fluid 
and  greenish.     The  intelligence  was  not  affected. 

At  the  autopsy,  there  was  some  sub-acute  pneumonia  of  the  poste- 
rior surface  of  both  lower  pulmonary  lobes.  There  was  also  consi- 
derable ulceration  of  the  lower  part  of  the  small  intestine,  and  the 
mucous  membrane  of  the  larfjre  intestine  was  finelv  (rranulated  and 


70 


PRIZE    ESSAY. 


roughened  throughout  its  extent. 


There  were  no  other  remarkable 


appearances. 

The  body  of  the  uterus  was  pale,  and  natural  in  size  and  consist- 
ency; but  there  were  some  morbid  appearances  about  the  os  and 
the  upper  part  of  the  vagina.  The  cervix  and  os  uteri  were  con- 
siderably swollen,  with  an  oedematous  aspect,  and  a  dark  red  and 
purple  colour  internally.  The  external  parts  of  the  os  and  upper 
portion  of  the  vagina  were  equally  dark  coloured,  and  covered  with 
large  patches  of  a  whitish,  semi-opake  exudation.  The  internal 
surface  of  the  body  of  the  uterus  was  lighter  coloured.  It  was 
finely  reticulated  over  the  greater  part  of  its  extent,  but  there  was 
a  spot  on  its  posterior  wall  which  was  smooth,  and  of  a  cicatrix-like 
appearance.  The  internal  surface  of  the  uterus  was  natural  in  con- 
sistency. 


Fi2.  13. 


Fif'.  14. 


Left  ovary  of  C.  L. 


Corpus  luteum  of  pregnancy- 
nine  months  and  a  half  after 
delivery. 


Both  ovaries  were  rather  large.  They  were  pale,  like  the  other 
organs,  and  entirely  destitute  of  vascularity.  Both  presented  exter- 
nally several  very  shallow,  bluish-looking  cicatrices,  but  the  left  had, 
in  addition,  on  its  anterior  surface,  two  puckered,  strongly  depressed 
cicatrices.  (Fig.  13.)  On  making  a  longitudinal  section,  there  was 
found,  immediately  beneath  the  deepest  of  these,  and  evidently  con- 


CORPUS  LUTEUM  OF  PREGNANCY.  71 

nccted  with  it,  a  solid  body,  having  a  nearly  circular  section.  (Fig. 
14.)  This  body  was  little  or  not  at  all  distinguishable  in  colour  from 
the  rest  of  the  ovarian  tissue,  and  might  easily  have  been  overlooked 
in  a  hasty  examination.  On  close  inspection,  however,  it  was  seen 
to  be  imbedded  in  the  substance  of  the  ovary,  from  which  it  was 
separated  by  a  sufficiently  distinct  line  of  demarkation.  It  contained 
in  its  centre  a  body  rather  whiter  and  more  opake  than  the  external 
parts,  while  the  latter,  on  minute  examination,  presented  indications 
of  being  traversed  by  radiating  lines.  The  whole  body  was  similar  in 
consistency  to  the  rest  of  the  ovary,  and  could  not  be  felt  at  all  from 
the  outside.     It  had  no  yellow  nor  red  coloration  in  any  part. 

Both  ovarieis  contained  many  Graafian  vesicles  in  an  inactive  con- 
dition, but  no  other  body  than  that  described  having  any  resem- 
blance to  a  corpus  luteum. 

Both  oviducts  were  natural  in  appearance  and  free  from  adhe- 
sions. 

There  can  be  no  doubt  that,  in  the  first  periods^  the  corpus  luteum 
follows  the  same  course  of  development,  whether  the  discharged 
ovum  becomes  impregnated  or  not.  Together  with  the  rupture  of 
the  vesicle,  the  same  efi'usion  of  blood  takes  place  in  either  case,  fol- 
lowed by  a  gradual  absorption  of  the  colouring  matter  of  the  clot,  and 
hypertrophy  and  folding  up  of  the  membrane  of  the  vesicle.  When, 
however,  the  ovum  becomes  impregnated,  and  continues  its  growth 
in  the  uterus,  the  corpus  luteum,  instead  of  reaching  its  maximum  of 
development  at  the  end  of  three  weeks,  and  afterward  undergoing 
a  rapid  process  of  atrophy,  continues  to  develop  itself  for  a  con- 
siderable period,  and  does  not,  in  fact,  become  very  decidedly  retro- 
grade until  after  the  termination  of  pregnancy.  At  the  same  time 
the  ordinary  periodical  processes  of  the  ovary  are  suspended.  No 
new  vesicles  protrude  themselves  from  its  surface,  and  even  those 
which,  at  the  time  of  conception,  happened  to  be  more  or  less  promi- 
nent, appear  again  to  recede  and  become  concealed  beneath  the  al- 
bugineous  coat. 

The  difference  in  the  progress  of  the  corpus  luteum,  however,  re- 
lates not  only  to  its  size,  but  also  to  its  general  characters  and 
aspect.  The  external  wall  becomes  much  thicker  in  proportion  to 
the  central  coagulum,  and  at  the  same  time  acquires  a  firmer  and 
more  highly  organized  structure.  Moreover,  the  colour,  both  of  the 
convoluted  wall  and  of  the  central  coagulum,  constitutes  an  import- 
ant means  of  distinction.     It  has  been  shown  that  the  corpus  luteum 


72  PRIZE    ESSAY. 

of  menstruation  retains  the  bright  yellow  colour  of  its  walls  till  the 
whole  body  has  become  much  reduced  in  size  ;  and  that  the  coagu- 
lum  in  its  interior  also  remains  more  or  less  stained  with  red  till  a 
late  period.  In  other  words,  the  substance  of  the  corpus  luteum 
diminishes  more  rapidly  than  its  colour  fades.  On  the  other  hand, 
if  pregnancy  occurs,  the  circumstances  are  reversed.  The  colour 
both  of  the  wall  and  the  coagulum  fades  rapidly  after  the  first  tAVO 
months,  while  the  substance  of  the  yellow  body  continues  to  increase ; 
consequently,  during  the  greater  part  of  gestation,  the  corpus  luteum 
of  pregnancy  will  be  distinguished  from  that  of  menstruation  by  the 
dull  hue  of  its  convoluted  wall,  and  by  the  absence  of  colour  in  the 
central  coagulum. 

The  occasional  existence  of  a  central  cavity  in  the  coagulum,  con- 
taining clear  fluid,  is  a  circumstance  which  has  been  noticed  by  seve- 
ral different  authors.  It  does  not  seem  to  be  an  essential  or  even  an 
ordinary  appearance  ;  since,  among  the  eighteen  observations  on  the 
human  female  which  have  been  detailed  in  the  preceding  pages,  we 
have  met  with  it  but  once  (Obs.  XII).  It  is  probably  occasioned 
by  an  early  closure  of  the  rupture  in  the  Graafian  vesicle,  by  which 
the  serum  of  the  effused  blood  is  retained  in  its  interior,  instead  of 
being  expelled  through  the  aperture  by  the  contraction  of  the  co- 
agulum. 

It  is  difiicult  to  ascertain  with  certainty  the  exact  period  of  preg- 
nancy at  which  the  corpus  luteum  attains  its  maximum  of  develop- 
ment. It  certainly  constitutes  a  very  perceptible  tumour  so  late  as 
the  middle  of  the  eighth  month,  and  most  of  the  older  writers  agree 
that  it  is  to  be  found  a  short  time  after  delivery.  Dr.  Robert  Knox 
has  drawn  up  a  table  of  measurements  of  the  corpus  luteum  at  dif- 
ferent periods  of  pregnancy,  collated  from  various  reliable  authori- 
ties, which  was  published  in  the  London  Medical  Grazette. 

The  table  is  as  follows: — 


CORPUS  LUTEUM  OF  PREGNANCY. 


73 


Br.  Knox's  Table  of  Measurements  of  the  Corpus  Luteum. 


No.  of  day  8  after 

Name  of 

Lon^  diame- 

Short diameter 

Thickness  of 

Diameter  of 

impregnation. 

reporter. 

ter  m  lines. 

in  lines. 

"  glandular 
part." 

"  central 
cavity." 

5 

Home 

9 

G 

1^ 

8 

" 

9 

6 

li 

46 

Lee 

9 

-'h 

1 

6 

62 

" 

6 

^ 

1 

3 

62 

Clarke 

H 

8 

3 

70 

Montgomery 

7 

6 

93 

" 

-J 

Ci 

2^ 

3 

108 

Keever 

9 

7 

2 

4^  and  2i 

1'  8 

Knox 

7 

6 

155 

W.  Hunter 

H 

7 

4iand  1^ 

186 

Rosderer 

6 

5 

3 

2 

186 

Montgomery 

6 

5 

3 

2 

186 

Home 

n 

4i 

1 

4 

201 

Lee 

6 

4i 

1 

3 

280 

Rffiderer 

7 

4 

280 

Montgomery 

6 

5 

289 

W.  Hunter 

6 

5 

285 

Knox 

4 

2§ 

IJ 

li 

It  appears  probable  from  this  table  that  the  period  of  the  greatest 
thickness  of  the  convoluted  wall,  the  structure  which  constitutes  the 
most  characteristic  portion  of  the  corpus  luteum,  continues  from  the 
beginning  of  the  third  to  the  end  of  the  sixth  month,  and  that  the 
entire  bulk  of  the  corpus  luteum  is  also  the  greatest  between  nearly 
the  same  periods.  After  delivery,  the  corpus  luteum  rapidly  dimin- 
ishes ;  though  its  characteristic  structure  is  still  to  be  distinguished 
for  many  months  by  close  inspection. 

The  corpus  luteum  of  pregnancy,  then,  differs  from  that  which  is 
merely  the  result  of  menstruation  in  several  important  particulars. 

I.  It  arrives  more  slowly  at  its  maximum  of  development,  and 
afterward  remains  for  a  long  time  as  a  very  noticeable  tumour,  instead 
of  undergoing  a  process  of  rapid  atrophy. 

II.  It  retains  a  globular,  or  only  slightly  flattened  form,  and  gives 
to  the  touch  a  sense  of  considerable  resistance  and  solidity. 

III.  Internally,  it  has  an  appearance  of  advanced  organization, 
which  is  wanting  in  the  corpus  luteum  of  menstruation. 

IV.  Its  convoluted  wall,  particularly,  attains  a  greater  development, 
this  portion  measuring  sometimes  so  much  as  three-sixteenths  to  one- 
fourth  of  an  inch  in  thickness,  while  in  the  corpus  luteum  of  menstrua- 
tion it  never  exceeds  one-eighth,  and  is  almost  always  less  tlian  that. 
This  difference  in  the  thickness  of  the  convoluted  wall  is  one  of  the 

6  ' 


74  PRIZE    ESSAY. 

most  important  points  of  distinction.     It  will  be  much  more  striking 
when  viewed  relatively  to  the  size  of  the  central  coagulum. 

V.  The  colour  is  not,  by  any  means,  so  decided  a  yellow,  but  a 
more  dusky  and  indefinite  hue. 

VI.  If  the  period  of  pregnancy  is  at  all  advanced,  it  is  not  found, 
like  the  corpus  luteum  of  menstruation,  in  company  with  unruptured 
vesicles  in  active  process  of  development. 

The  preceding  histories  and  observations  will  serve  to  show  how 
very  imperfect  are  some  of  the  marks  which  various  writers  have 
heretofore  laid  down  as  distinguishing  "true"  from  "false"  corpora 
lutea.  Dr.  Montgomery*  gives  seven  characteristics  by  which,  he 
says,  the  "false"  or  "virgin"  corpora  lutea  may  be  recognized. 

"  I.  There  is  no  prominence  or  enlargement  of  the  ovary  over 
them." 

This  is  manifestly  incorrect,  for  the  corpora  lutea  of  menstruation 
often  cause  a  noticeable  protuberance  on  the  surface  of  the  ovary, 
as  may  be  seen  in  Observations  II.,  IV.,  V.,  VL,  and  VII. 

"  II.  The  external  cicatrix  is  almost  always  wanting."  According 
to  the  present  observations,  an  external  cicatrix  is  always  present  in 
the  corpus  luteum  of  menstruation,  and  in  fact  must  necessarily  be 
so,  since  these  bodies  result  from  the  rupture  of  a  vesicle,  in  the 
same  manner  with  the  corpora  lutea  of  pregnancy. 

"  III,  There  are  often  several  of  them  found  in  both  ovaries,"  &c. 
This  is,  no  doubt,  a  very  important  distinction,  since  we  never  find 
more  than  one  corpus  luteum  of  pregnancy  at  a  time,  unless  in  cases 
of  twins ;  and  then  the  two  corpora  lutea  are  evidently  of  the  same 
date,  and  have  the  same  aspect,  while  the  co-existent  corpora  lutea  of 
menstruation  are  usually  in  many  difierent  stages  of  retrogression. 

"IV.  They  present  no  trace  whatever  of  vessels  in  their  substance, 
of  which  they  are,  in  fact,  entirely  destitute,  and  of  course  cannot 
be  injected." 

According  to  the  present  observations,  the  distribution  of  vessels 
in  the  two  difierent  kinds  of  corpora  lutea  is  the  same.  In  both,  the 
substance  of  the  convoluted  wall  itself  is  non-vascular;  and  the 
vessels  exist  only  in  the  interstices  of  the  folds.  This  fact  is  very 
easily  demonstrated  in  a  corpus  luteum  of  menstruation  when  com- 
pletely developed,  as  the  convolutions  are  here  pretty  easily  sepa- 
rated from  each  other ;  but  in  the  corpus  luteum  of  pregnancy  the 
new  growth  from  the  internal  surface  of  the  vesicle  has  been  so 

•  Signs  and  Symptoms  of  Pregnancy,  p.  245. 


CORPUS  LUTEUM  OF  PREGNANCY.  75 

abundant,  and  the  convolutions  are  consequently  pressed  so  firmly 
together,  that  it  is  not  always  easy  to  decide  whether  a  section  has 
divided  the  substance  of  the  wall,  or  only  by  accident  passed  between 
two  convolutions;  particularly  as  we  have  not  so  strong  a  contrast 
in  colour,  to  assist  us,  between  the  yellow  wall  and  red  vessels,  as 
exists  in  the  corpus  luteum  of  menstruation. 

"V.  Their  texture  is  sometimes  so  infirm  that  it  seems  to  be  merely 
the  remains  of  a  coagulum,"  &c.  This  is  frequently  a  good  distin- 
guishing mark. 

"VI.  In  figure  they  are  often  triangular,  or  square,  or  of  some 
figure  bounded  by  straight  lines."  This  has  already  been  seen  to  be 
an  appearance  frequently  presented  by  the  corpus  luteum  of  menstrua- 
tion, at  an  advanced  period  of  atrophy. 

"  VII.  They  never  present  either  the  central  cavity,  or  the  radi- 
ated or  stelliform  white  line  which  results  from  its  closure."  This 
last  distinction  is  so  exceedingly  incorrect  that  it  is  difiicult  to  under- 
stand how  it  could  have  been  laid  down  by  such  an  observer  as  Dr. 
Montgomery.  The  corpus  luteum  of  menstruation  always  presents 
a  central  cavity,  i.  e.,  a  space  included  by  the  convoluted  wall,  which 
space  is  filled  by  a  coagulum ;  and  as  the  whole  yellow  body  becomes 
atrophied,  the  coagulum  is  transformed  into  a  radiated  or  stelliform 
cicatrix,  more  or  less  coloured  with  blood,  according  to  the  rapidity 
with  which  the  absorption  of  the  hsematin  has  proceeded. 

There  can  be  no  doubt,  therefore,  of  the  existence  of  certain 
distinct  and  reliable  marks  by  which  the  corpus  luteum  may  be 
recognized  as  a  sign  of  pregnancy,  and  distinguished  from  all  other 
appearances,  either  morbid  or  physiological,  to  be  met  with  in  the 
ovary.  The  length  of  time  which  elapses  before  its  disappearance 
is  alone  sufficient  to  show  that  it  is  a  peculiar  and  distinctive  phe- 
nomenon. It  has  been  demonstrated,  in  the  foregoing  pages,  that  the 
corpus  luteum  of  menstruation  becomes  atrophied  in  a  very  short 
space  of  time.  Other  observations,  also,  bear  testimony  to  the  same 
fact.  N^grier,*  who  considers  all  corpora  lutea  as  identical,  says 
that  the  remains  of  the  ruptured  vesicle  diminish  successively  with 
so  much  regularity  that  we  "  can  appreciate  the  loss  of  voliime 
which  takes  place  from  one  month  to  another."  "It  is  in  accordance 
with  such  facts  that  I  have  been  able  to  calculate  that  five  to  six 
months  are  sufficient  to  reduce  the  most  voluminous  corpora  lutea  to 
the  size  of  a  grape-seed;  and  that  after  two  years  a  bluish  stain  is 
often  the  only  vestige  that  remains." 

*    Page  79. 


76  PKIZE    ESSAY. 

Raciborski*  states  also  that  a  period  of  four  to  six  months  is  suffi- 
cient to  reduce  the  corpus  luteum  to  an  insignificant  remnant ;  "  a 
simple  slate-coloured  or  yellowish  trace." 

Notwithstanding  this,  when  the  menstrual  periods  return  with 
reo'ularity,  new  corpora  lutea  are  so  rapidly  produced  that  we  meet 
with  many  of  them  of  different  sizes  in  the  same  subject.  Thus, 
in  Obs.  X.  we  have  four  of  these  bodies,  in  Obs.  VI.  six,  and  in 
Obs.  IX.  so  many  as  eight,  co-existing  in  the  same  ovaries.  On 
the  other  hand,  the  corpus  luteum  of  pregnancy,  after  a  certain 
period  has  elapsed,  is  found  alone.  It  has  outlived  all  vestiges  of 
the  vesicles  previously  ruptured,  and  no  new  ones  have  come  for- 
ward to  form  fresh  corpora  lutea.  If,  however,  the  yellow  body  of 
menstruation  were  entirely  similar  to  that  of  pregnancy,  produced 
every  month,  and  yet  remaining  nearly  undiminished  for  the  greater 
part  of  a  year,  we  should  find,  in  almost  every  female  dead  between 
the  ages  of  fifteen  and  forty-five,  the  ovaries  crowded  with  promi- 
nent solid  tumours  which  could  not  fail  to  be  recognized  on  the  most 
superficial  inspection.  Pouchet  would  then  never  have  been  obliged 
to  account  for  the  failure  of  older  observers  to  discover  corpora 
lutea  in  the  ovaries  of  virgins. f  "  If  certain  physiologists  (De 
Graaf,  Morgagni,  Haller),  not  having  been  favoured  by  circum- 
stances, never  discovered  corpora  lutea  in  the  virgin  females  of 
mammalia,  we  cannot,  nevertheless,  at  the  present  day  deny  their 
existence,"  &c.  These  observers  could  hardly  have  failed  to  dis- 
cover them  if  the  corpora  lutea  of  menstruation  continued  perma- 
nent for  any  length  of  time.  It  is  this  very  circumstance  of  their 
rapid  atrophy  and  disappearance,  joined  to  the  fact  that  almost  all 
grave  diseases  check  the  ovarian  processes  for  some  time  previous  to 
death,  that  prevents  our  meeting  more  frequently  with  specimens  of 
these  bodies  at  ordinary  post-mortem  examinations.  Pouchet  him- 
self gives  some  observations  which  of  themselves  establish  partially 
the  distinction  above  alluded  to.  One  of  them  he  adduces  while 
speaking  of  the  proofs  of  the  regular  maturation  and  discharge  of 
ova  in  virgins.  "  In  the  case  of  a  young  woman,"  he  says,  "  twenty 
years  of  age,  I  had  the  good  fortune  to  discover  together  Graafian 
vesicles  and  their  contents  in  all  stages  of  development  and  retro- 
gression. This  woman  had  never  borne  children,  and  presented  all 
the  marks  of  virginity.  The  ovaries  presented  on  the  surface  of 
their   fibrous   tunic   many    very   noticeable    cicatrices,   vestiges  of 

*  Page  436.  t  Page  125. 


CORPUS  LUTEUM  OF  PREGNANCY.  77 

obsolete  Graafian  vesicles  wliicli  had  previously  discharged  their 
ovum.  In  the  interior  of  the  organs  were  to  be  seen  many  anfrac- 
tuosities,  which  were  probably  merely  Graafian  vesicles  which  had 
been  more  recently  ruptured.  This  appeared  probable  from  the 
condition  of  their  internal  membrane,  which  was  of  a  brownish 
colour,  and  appeared  no  longer  to  be  in  an  active  condition.  Finally 
there  existed,  near  the  surface  of  the  organs,  eight  vesicles,  in  dif- 
ferent stages  of  development,  and  varying  from  one-half  to  one- 
sixth  of  an  inch  in  diameter.  Their  internal  membrane  was  like  a 
mucous  surface,  ruddy  and  very  vascular,"  &c.  &c. 

This  girl's  menstruation  and  ovulation  had  evidently,  therefore,  as 
Pouchet  supposes,  gone  on  in  an  uninterrupted  manner  till  near  the 
time  of  her  death.  Why,  then,  if  the  menstrual  corpus  luteum  lasts 
as  long  as  that  of  pregnancy,  did  he  not  find  many  yellow  bodies  in 
full  development,  instead  of  mere  "anfractuosities"  with  a  "brown- 
ish-coloured and  inactive-looking  internal  membrane?"  The  same 
remark  may  be  made  with  regard  to  other  similar  observations,  as 
those  by  Bischoff  already  referred  to  (op.  cit.  p.  50),  and  those  by 
Dr.  Seymour,  when  he  says,  "  I  have  examined  ovaria  in  many  in- 
stances; many  had  ova  (Graafian  vesicles)  ready  for  impregnation 
large,  projecting,  vascular:  yet  no  corpora  lutea  were  visible."  In 
these  subjects,  the  development  of  the  vesicles  had  evidently  suf- 
fered only  a  very  recent  arrest,  and  yet  the  corpora  lutea  had  be- 
come so  much  diminished  as  to  escape  observation. 

On  the  other  hand,  it  cannot  be  doubted  that  the  corpus  luteum 
of  pregnancy  does  remain,  throughout  the  period  of  gestation,  too 
bulky  and  remarkable  an  object  to  be  very  readily  overlooked.  This 
is  established  by  the  testimony  of  many  other  observers,  as  well  as 
by  that  of  the  foregoing  cases.  Raeiborski,*  indeed,  not  recogniz- 
ing any  difference  between  the  two  classes  of  yellow  bodies,  goes 
so  far  as  to  deny  positively  that  the  corpus  luteum  is  ever  visible  at 
the  termination  of  pregnancy.  "We  are,"  he  says,  "at  a  loss  to 
understand  the  grounds  upon  which  most  of  the  writers  on  midwifery 
and  legal  medicine  have  laid  down  the  presence  of  a  corpus  luteum 
in  the  ovaries  as  the  sign  of  a  recent  delivery.  The  process  of 
ovulation  having  been  suppressed  during  the  period  of  pregnancy, 
the  pretended  corpora  lutea,  which  are  only  different  forms  of  the 
anatomical  marks  of  preceding  ovulations,  have  had  more  than  suf- 
ficient time  to  become  entirely  effaced,  and  we  never  meet  with 

•  Page  436. 


78 


PRIZE     ESSAY. 


anything  more  than  feeble  traces  of  them  in  women  who  die  after 
delivery." 

The  direct  testimony,  however,  of  many  reliable  authors,  such,  for 
instance,  as  those  quoted  in  Dr.  Knox's  table,  is  certainly  not  to  be 
outweighed  by  a  sweeping  assertion  like  the  foregoing;  particularly, 
as  many  of  the  descriptions  are  accompanied  with  drawings.  Mont- 
gomery gives  quite  a  number  of  coloured  plates  of  the  corpus  luteum 
at  different  periods  of  pregnancy;  and  states,  with  regard  to  the 
time  of  its  disappearance,*  that  he  has  met  with  it  "distinctly  visi- 
ble so  late  as  the  fifth  month  after  delivery."  Dr.  Lee,  in  his  "Lec- 
tures on  Midwifery,"  already  referred  to,  gives  two  wood-cuts  of 
corpora  lutea;  one  of  them  in  the  second  month  of  pregnancy,  half 
an  inch  in  length,  and  the  other  in  the  fourth  month,  nearly  seven- 
eighths  of  an  inch  in  length. 

William  Hunter,  also,  in  his  plates  of  the  gravid  human  uterus, 
gives  two  representations  of  the  corpus  luteum.  One,  at  the  begin- 
ning of  the  fifth  month,  is  three-quarters  of  an  inch  in  length,  and 
nine-sixteenths  in  depth  ;  the  other,  at  term,  is  nearly  circular  in 
section  and  half  an  inch  in  diameter. 


Fig.  ]5. 


Fi-    16. 


William  Hunter's  plate  of  the  human  corpus 
luteum,  at  the  lx;ginningof  the  lil'ih  monih. 


William  Hunter';*  plate  of  the  human  corpus 
luteum  at  term. 


•   Op.  cit.  p.  227. 


CORPUS  LUTEUM  OF  PREGNANCY.  79 

The  foregoing  account  of  the  corpus  luteum  of  menstruation  and 
pregnancy  must  be  considered  as  differing,  to  some  extent,  from  all 
the  observations  hitherto  published.  Sulficient,  however,  has  al- 
ready been  said  in  a  previous  part  of  the  treatise  to  show  the  dis- 
crepancy which  has  existed  among  authors  on  the  subject,  and  to 
demonstrate  the  justice  of  Raciborski's  remark,  that  "  science  has 
so  far  possessed  only  vague  ideas,  or  rather  assertions  altogether 
false  on  the  nature  of  the  alterations  which  merit  the  name"  of 
corpora  lutea.  A  memoir  by  Dr.  Frank  Renaud,  however,*  has 
already  been  mentioned  as  containing  much  the  best  account  of 
these  bodies  heretofore  published.  That  writer,  nevertheless,  does 
not  acknowledge  the  regular  and  periodical  discharge  of  ova  and 
formation  of  corpora  lutea ;  consequently,  those  bodies  which  he 
designates  as  "  false  corpora  lutea"  he  does  not  regard  as  necessa- 
rily connected  with  menstruation.  "The  theory,"  he  says,  "  that 
would  indicate  each  menstrual  period  to  be  co-existent  with  the 
secretion  of  a  small  yellow  body  in  the  ovaries  requires  facts  much 
more  imperative  than  any  yet  advanced."  He  therefore  thinks  it 
best  to  "receive  with  caution  a  theory  that  requires  so  much  show 
of  ingenuity  for  its  establishment." 

Dr.  R.  also  lays  down  one  or  two  points  of  distinction  between 
"true  and  false"  corpora  lutea  which  it  would  be  impossible  to 
admit,  according  to  the  observations  in  the  present  paper.  He 
states,  for  instance,  that  "  the  yellow  secretion  of  the  false  corpus 
luteum  is  contained  within  the  inner  ovisac  ;"  but  that  "  true  corpora 
lutea  are  always  to  be  found  located  between  the  proper  tunics  of 
the  Graafian  follicles,  or,  in  other  words,  between  the  two  ovisacs." 
In  reality,  the  situation  of  the  yellow  matter  in  the  two  bodies  is 
the  same ;  it  varies  only  in  amount,  and  in  some  peculiarities  of 
intimate  structure. 

Another  distinction  of  Dr.  Renaud  is  that  the  true  corpus  luteum 
is  vascular,  while  the  false  is  destitute  of  vessels,  and  cannot  be  in- 
jected. 

Reasons,  however,  have  already  been  given  for  believing  that  the 
distribution  of  vessels  is  the  same  in  both  bodies,  though  they  are 
certainly  often  more  distinct  to  the  eye  in  the  "  true  corpus  luteum," 
owing  to  the  dull  colour  of  the  yellow  matter  and  the  greater  depth 
of  its  anfractuosities. 

Neither  does  Dr.  Renaud,  in  his  memoir,  give  any  such  regular 

•  Edinburgh  Monthly  Journal  of  Med.  Science,  Aug.  1S45. 


80  PRIZE    ESSAY. 

and  detailed  comparison  of  true  and  false  corpora  lutea  as  could  be 
called  a  demonstration  of  the  difference  between  them.  Indeed,  it 
was  only  by  a  reference  to  previous  observations  of  my  own  that  I 
was  enabled,  on  meeting  with  Dr.  R.'s  paper,  to  recognize  its  great 
superiority,  in  point  of  accuracy,  to  the  numerous  other  accounts, 
whose  conflicting  statements  have  involved  this  subject  in  so  much 
confusion.  How  otherwise,  indeed,  could  one  ever  be  enabled  to 
discriminate  in  a  case  like  this,  where  the  facts  are  so  obscure  and 
the  opinions  of  authors  so  various?  It  is  only  by  arranging  a 
detailed  history  of  the  corpus  luteum,  and  by  oiFering  the  proofs 
together  with  the  assertions,  that  we  can  ever  expect  to  settle  the 
question  in  a  manner  satisfactory  to  the  general  reader. 


PART   III. 
OBSERVATIONS  ON  ANIMALS. 


It  so  frequently  happens  that  a  great  deal  of  light  is  thrown  upon 
obscure  portions  of  human  physiology  by  parallel  observations  on 
the  lower  animals,  that  it  seems  hardly  excusable,  in  a  question  in- 
volving much  difficulty,  to  neglect  so  obvious  a  source  of  additional 
information.  Consequently,  it  has  been  thought  best,  in  the  present 
instance,  to  extend  our  inquiries  concerning  the  corpus  luteum  into 
other  classes  of  the  mammalia.  Among  the  best  subjects  for  that 
purpose  are  the  cow  and  the  sheep;  not  only  on  account  of  the  com- 
parative ease  with  which  specimens  can  be  obtained  from  healthy 
subjects  slaughtered  for  the  market,  but  also  from  the  circumstance 
that,  in  a  large  proportion  of  these  cases,  the  animal  is  found  to  be 
more  or  less  advanced  in  the  early  part  of  pregnancy.  The  writer 
having  also  been  favoured  by  chance  in  obtaining  one  or  two  speci- 
mens from  the  cow  at  a  much  later  period  of  gestation,  it  was  thought 
too  good  an  opportunity  for  investigation  to  be  lost ;  and  he  has  been 
enabled,  accordingly,  to  obtain  a  series  of  corpora  lutea  in  their 
different  stages,  which,  though  not  quite  complete,  will  not,  it  is 
thought,  be  found  entirely  without  value. 

The  frequency  with  which  the  periods  of  heat  recur  in  these  ani- 
mals also  affords  an  opportunity  of  examining  an  abundance  of 
corpora  lutea  unconnected  with  pregnancy.  Indeed,  among  all  the 
cases  in  -which  these  observations  Avere  made  during  the  months  of 
December  and  January,  I  never  failed  to  discover  these  bodies  in 
the  ovary  except  in  a  few  instances,  in  which  the  animals  were  very 
young,  and  ovulation  had  evidently  not  yet  been  fully  established. 

The  exact  periods  at  which  the  venereal  excitement  returns  is  not 
very  easily  ascertained.  The  butchers  and  drovers  vary  a  little  in 
their  account  of  it;  some  stating  the  interval,  in  the  cow,  to  be 
about  six  weeks ;  others  about  four  weeks.  In  the  sheep,  during 
cool  weather,  it  is  said  to  be  even  less  than  that.     I  am  informed, 


82  PRIZE    ESSAY. 

however,  by  Col.  Jacques,  of  Medford,  who  has  been  for  many  years 
an  extensive  breeder,  that  the  cow,  if  kept  from  the  bull,  is  at  heat, 
for  twenty-four  hours,  as  often  as  once  in  two  or  three  weeks  through- 
out the  year.  With  regard  to  the  sheep,  he  is  not  so  positive,  but 
thinks  that  the  periods  return  about  as  frequently  as  in  the  cow. 

For  our  present  purposes,  indeed,  it  is  not  necessary  to  ascertain 
these  intervals  precisely.  It  is  sufficient  to  know  that  they  are  very 
short,  in  order  to  comprehend  how  rapidly  the  corpora  lutea  become 
atrophied  and  disappear,  unless  their  ordinary  course  of  development 
is  modified  by  the  occurrence  of  pregnancy. 


OBSERVATION    XIX. 

A  Graafian  vesicle  recently  ruptured — Corpus  luteum  of  the  preceding  ovula- 
tion retrograde — Eight  others  quite  obsolete. 

I  OBTAINED  the  uterus  and  ovaries  of  a  healthy  cow,  slaughtered 
for  the  market,  December  12th,  1850.  The  uterus  was  empty,  and 
there  was  nothing  of  note  discovered  in  the  tubes. 

One  of  the  ovaries  was  of  the  usual  size,  and  without  any  remark- 
able appearance  externally  on  a  superficial  examination.  There 
were  quite  a  number  of  Graafian  vesicles  to  be  seen,  not  prominent, 
but  easily  detected  at  various  spots  immediately  underneath  the 
peritoneum.  On  close  examination;  an  opening  was  discovered  on 
one  of  the  lateral  surfaces  of  the  ovary  leading  into  the  interior  of 
a  Graafian  vesicle.  The  walls  of  the  vesicle  had  collapsed  at  the 
surface  of  the  ovary,  and  the  edges  of  the  aperture  having  conse- 
quently been  brought  in  contact,  the  opening  was  not  at  first  notice- 
able. On  distending  the  vesicle,  however,  with  a  blowpipe,  it  became 
very  distinct,  of  an  oval  form,  with  thin  sharp  edges,  and  a  little 
over  one-sixteenth  of  an  inch  in  length.  (Fig.  17.)  There  was  no 
ragged  or  lacerated  appearance,  nor  any  unusual  vascularity  about 
the  rupture,  nor  any  effusion  of  blood.  The  vesicle,  cut  open,  was 
quite  empty,  and  its  walls  smooth,  shining,  and  vascular  as  usual. 
It  was  of  a  very  moderate  size — not  over  a  quarter  of  an  inch  in 
diameter — while  very  near  it  was  another  vesicle,  unruptured,  half 
an  inch  in  diameter.  Except  for  the  opening  in  its  walls,  the  rup- 
tured vesicle  could  not  have  been  distinguished  from  any  other. 


OBSERVATIONS    ON    ANIMALS. 


83 


The  opposite  ovary  had  on  its  free  edge  a  roundish  yellow  spot 
where  the  fibrous  tunic  was  wanting.  There  was  no  prominence  at 
this  spot,  but  immediately  underneath  was  a  corpus  luteum  of  con- 
siderable size,  but  still  evidently  retrograde.  This  body  was  solid, 
with  a  nearly  circular  section,  five-eighths  to  three-quarters  of  an 
inch  in  diameter,  and  showed  very  plainly  the  deep  foldings  of  the 
yellow  walls,  with  a  white  cicatrix  in  the  centre,  from  which  a  wavy 
line  proceeded  to  the  exterior  of  the  ovary  indicating  the  situation 
of  the  rupture.  (Fig.  18.)  The  substance  of  the  wall  was  softish, 
of  a  bright  stone-yellow  colour.  Its  exterior  presented  a  very  thin 
investing  membrane,  to  which  it  was  so  closely  adherent  that  it  could 
not  be  separated  without  tearing  open  the  convolutions,  and  which 
had,  indeed,  the  appearance  of  a  mere  membranous  surface.  Ex- 
ternal to  this  were  numerous  and  dense  laminae  of  cellular  tissue. 


Fig.  17. 


Fig.  18. 


Ovary  of  an  unimpregnated  cow ;  i-how- 
ing  a  reoently-rupf  iired  Graafian  ves^i- 
cle,  as  it  appeared  distended  by  the 
blowpipe. 


Corpus  luteum  of  the  unimprenmated  cow 
at  the  time  of  the  rupture  of  the  suc- 
ceeding- vesicle. 


There  were  also  in  the  same  ovary  five  superficial  obsolete-look- 
ing bodies,  corresponding  to  coloured  spots  on  the  surface.  The 
largest  was  three-sixteenths  of  an  inch  deep,  and  of  a  dingy-yellow 
colour,  the  others  successively  diminishing  in  size,  and  of  a  brick- 
red  tinge.  They  were  all  of  a  close,  reticulated-looking  texture,  ■ 
and  without  any  distinct  investing  membrane,  but  immediately  con- 
nected with  the  ovarian  tissue,  so  that  they  could  not  be  enucleated. 


84  PRIZE    ESSAY. 

The  larger  still  showed  a  whitish  or  transparent  central  cicatrix, 
but  the  smaller  presented  no  trace  of  it. 

The  other  ovary  also  contained  three  similar  bodies. 

There  were  many  Graafian  vesicles  to  be  seen,  of  moderate  size 
and  slightly  prominent  on  the  surface. 


OBSERVATION   XX. 

Ruptured  Graafian  vesicle  in  process  of  transformation  into  a  corpus  luteum. 

A  COW  was  slaughtered  December  12th,  1850,  of  which  the  uterus 
was  empty. 

One  of  the  ovaries,  an  inch  and  a  half  in  length,  showed  at  one 
extremity  a  circular  spot,  a  quarter  of  an  inch  in  diameter,  where 
the  fibrous  tunic  was  wanting.  There  was  at  this  spot  a  slight 
eminence,  of  a  very  pale  yellowish  tinge,  hardly  differing  from  that 
of  the  rest  of  the  ovary  except  just  at  its  summit,  where  it  was 
deeply  stained  of  a  blood-red  colour,  and  about  its  circumference, 
where  there  was  a  bright  circle  of  vascularity.  The  peritoneum 
extended  completely  over  its  surface.     (Plate  III.  Fig.  1,  b.) 

On  the  other  extremity  of  the  organ  was  the  yellow  protrusion  of 
a  retrograde  corpus  luteum.  This  protrusion  was  of  a  light  yellow 
colour  and  of  an  oval  form,  measuring  three-eighths  of  an  inch  in 
its  long  diameter.  The  corpus  luteum  underneath  could  still  be  felt 
through  theovarian  parietes.     (Plate  III.  Fig.  1,  a.) 

On  making  a  longitudinal  incision,  so  directed  as  to  pass  through 
the  centre  of  each  of  these  spots,  a  body  was  found,  situated  beneath 
the  first,  three-eighths  of  an  inch  deep,  and  of  a  yellowish-white 
colour,  like  fibrin,  hardly  differing  in  tint  from  the  remainder  of  the 
ovarian  tissue.  It  contained  a  cavity,  the  proportionate  size  of  which 
is  represented  in  Plate  III.  Fig.  2,  b.  This  cavity  communicated 
by  a  wide  passage  with  the  exterior  of  the  ovary,  where,  however, 
it  was  closed  by  peritoneum,  which  had  been  reproduced  over  the 
summit  of  the  prominence.  The  cavity  contained  a  little  reddish 
serum  and  a  plug  of  fibrin,  lying  loose  towards  its  deeper  part,  but 
•adherent  to  the  peritoneum  where  it  extended  over  the  top  of  the 
passage.  There  was  no  lining  membrane  to  the  cavity^  but  the  plug 
was  in  immediate  contact  with  the  foldings  of  the  wall  which  pro- 


OBSERVATIONS    ON    ANIMALS.  85 

jected  into  tlie  interior.  These  convolutions  could  be  readily  sepa- 
rated and  unfolded  from  the  inside.  Externally  the  wall  was 
adherent  to  a  single  thin  vascular  membrane,  with  which  it  could 
be  removed  entire  ;  and  beyond  this  were  the  usual  irregular  layers 
of  cellular  tissue.  The  corpus  luteum  at  the  other  extremity  of  the 
ovary  was  a  little  over  half  an  inch  in  depth,  and  of  a  bright  yellow 
colour,  slightly  tinged  with  orange.  (Plate  III.  Fig.  2,  a.)  It  was 
solid,  and  of  rather  a  firm  consistency;  its  central  cicatrix  somewhat 
indistinct,  but  its  substance  everywhere  intersected  by  streaks  of 
dense  cellular  tissue,  which  appeared  to  have  encroached  upon  the 
.  yellow  matter.  The  substance  of  this  corpus  luteum  had  the  same 
relation  to  the  external  parts  as  in  other  cases ;  only  the  adhesion 
between  its  proper  membrane  and  the  outer  layers  of  cellular  tissue 
was  closer  than  in  the  earlier  specimens,  so  that  it  could  not  readily  be 
enucleated.  The  outer  layers  were  also  particularly  thick  and  dense. 
The  same  ovary  had  on  its  surface  two  small  brick-red  spots,  cor- 
responding to  obsolete  corpora  lutea  of  the  same  colour:  the  largest 
an  eighth  of  an  inch  deep.  The  other  ovary  contained  six  similar 
bodies,  the  largest,  which  was  yellowish  in  colour,  one-quarter  of 
an  inch  in  diameter;  the  others  were  red,  and  diminished  successively 
in  size.  Both  ovaries  showed  several  slightly  prominent  Graafian 
vesicles,  the  largest  three-eighths  of  an  inch  in  diameter. 


OBSERVATION   XXI. 

Corpus  luteum  of  the  cow  at  Its  maximum  of  development — Eight  othera 

obsolete. 

Uterus  and  ovaries  of  a  cow  slaughtered  December  11th,  1850. 
The  uterus  was  empty. 

One  of  the  ovaries  measured  one  inch  and  three-eighths  in  length. 
On  its  free  edge  was  a  large  yellowish  eminence,  of  a  rather  firm 
consistency,  the  summit  of  which  was  destitute  of  fibrous  covering, 
and  had  the  aspect  of  a  protruding  fungous  growth,  invested  only 
by  peritoneum,  which  allowed  the  yellow  colour  of  the  corpus  luteum 
to  show  through  very  distinctly.  (Plate  III.  Fig.  3.)  This  fungous 
protuberance  was  of  an  oval  shape,  and  nearly  three-fourths  of  an  inch 
in  its  long  diameter.     About  its  base,  where  the  fibrous  tunic  of  the 


86  PRIZE    ESSAY. 

ovary  terminated,  vras  a  somewhat  distinct  constriction.  Its  centre 
showed  a  distinct,  radiated,  white  line.  The  sides  of  the  eminence 
towards  its  summit  were  covered  with  large  red  and  purple  vessels. 

On  a  longitudinal  section,  the  corpus  luteum  was  seen  to  be  of 
very  large  size ;  nearly  one  inch  in  its  long  diameter.  It  was  solid, 
with  a  distinct,  central,  whitish,  radiated  cicatrix,  and  strongly 
marked  convolutions.  Its  colour  was  yellowish,  with  an  orange  tint. 
There  were  some  minute  red  vessels,  ramifying  in  the  interstices  of 
the  convolutions.  (Plate  III.  Fig.  4.) 

This  corpus  luteum  had  the  same  relations  to  the  investing  mem- 
branes as  in  other  cases,  ^.  e.,  it  was  covered  externally  by  a  single, 
thin,  transparent,  vascular  tunic,  to  which  it  was  adherent,  and  out- 
side of  this  membrane  were  several  irregular  layers  of  cellular  tissue, 
forming  a  nidus  or  receptacle  for  the  body.  The  first  membrane 
penetrated  all  the  sinuosities  of  the  yellow  matter,  as  the  pia  mater 
penetrates  between  the  convolutions  of  the  brain,  while  the  cellular 
layers  passed  directly  across  them,  in  the  manner  of  the  arachnoid. 

The  ovary  contained  also  Graafian  vesicles  of  moderate  size, 
varying  from  three-sixteenths  of  an  inch  in  diameter  downward,  and 
four  coloured  spots  on  its  surface,  marking  the  situations  of  obsolete 
corpora  lutea.  The  largest  of  these  latter  bodies  was  a  quarter  of 
an  inch  in  depth,  and  of  a  yellowish  colour.  The  others  diminished 
successively  in  size,  and  were  of  a  brick-red  tinge.  They  were 
similar  in  texture  to  those  already  described  in  previous  observations. 

The  opposite  ovary  contained  four  obsolete  reddish-yellow  bodies 
superficially  situated,  and  many  Graafian  vesicles,  some  of  which 
were  moderately  prominent;  the  largest  half  an  inch  in  diameter. 
Nothing  else  remarkable. 


OBSERVATION    XXII. 

Corpus  luteum  of  the  cow,  beginning  to  retrograde — Graafian  vesicle  in  the 
opposite  ovary  very  prominent,  and  near  the  time  of  rupture — Eight  obsolete 
corpora  lutea. 

Uterus  and  ovaries  of  a  cow  slaughtered  Dec.  5th,  1850.  The 
uterus  contained  several  drachms  of  a  clear,  serous-looking  fluid, 
but  no  foetus  nor  any  distinguishable  ovum. 

One  of  the   ovaries  was  one  inch  and  three-eighths  in  length. 


OBSERVATIONS    ON    ANIMALS.  87 

It  was,  for  the  most  part,  pale  externally.  Its  surface  showed  some 
slight  sinuosities,  and  three  small  yellowish-red  spots,  the  longest  mea- 
suring nearly  one-eighth  of  an  inch.  There  were  also  several  trans- 
lucent Graafian  vesicles,  situated  immediately  beneath  the  albugineous 
tunic,  but  none  so  prominent  as  to  distend  the  peritoneal  coat.  On 
one  of  its  lateral  surfaces  was  a  bulky,  nipple-shaped  protuberance, 
of  a  yellowish  colour,  and  firm,  resisting  feel.  It  was  covered  with 
a  few  small  red  vessels,  but  the  vascularity  was  much  less  pronounced 
than  in  the  preceding  case.  In  other  respects,  it  resembled  that 
last  described,  except  for  being  considerably  smaller.  On  the  sides  of 
the  protuberance  the  albugineous  tunic  was  much  thinned  and  nearly 
transparent,  and  on  the  summit  it  was  entirely  wanting  for  a  space 
of  rather  more  than  three-eighths  of  an  inch  diameter,  where  the 
surface  was  very  yellow,  and  had  a  soft,  velvety  appearance.  The 
middle  of  the  summit  showed  an  indistinct,  whitish,  radiated  line, 
with  small  red  vessels  ramifying  from  it  as  a  centre.  (Plate  III. 
Fig.  5.) 

This  protuberance  was  formed  by  the  projection  of  a  corpus  luteum, 
which,  on  a  section,  was  seen  to  be  of  an  ovoid  shape,  three-quarters 
of  an  inch  in  its  longest  diameter,  and  of  a  stone-yellow  colour.  It 
was  solid,  with  a  central  linear  cicatrix,  and  numerous  convolutions 
visible  throughout  its  substance.  It  showed  no  vessels  except  a  few 
occasionally  penetrating  the  interstices  between  the  convolutions. 
There  were  none  whatever  in  the  substance  of  the  yellow  matter. 
As  in  the  cases  already  described,  the  yellow  matter  was  closely  ad- 
herent to  a  thin,  transparent,  vascular  investing  membrane,  and  there 
was  no  distinct  membrane  external  to  this;  only  irregular  laminae  of 
cellular  tissue.     (Plate  IV.  Fig.  1.) 

On  cutting  through  the  three  reddish  spots  on  the  surface  of  the 
ovary,  there  was  found  immediately  beneath  each  a  flattened  solid 
body,  of  a  nearly  brick-red  colour,  and  appearing  to  the  naked  eye 
composed  of  areolar  tissue.  The  two  larger  were  nearly  three-six- 
teenths of  an  inch  in  diameter  ;  the  third  was  somewhat  smaller.  A 
central  cicatrix  was  easily  distinguishable.  They  were  tough,  and 
closely  adherent  to  the  adjacent  ovarian  tissue.  They  had  no  dis- 
tinct investing  membrane,  and  could  not  be  enucleated  from  the  ovary. 

The  opposite  ovary  contained  numerous  Graafian  vesicles  in  active 
development.  One  of  them  was  exceedingly  large  and  prominent, 
nearly  three-quarters  of  an  inch  in  diameter,  and  protruding  strongly 
from  the  surface  of  the  ovary.  The  tunics  of  the  ovary  were  very 
thin  over  the  whole  prominence,  and  at  its  summit  seemed  reduced 


88 


PRIZE    ESSAY. 


19. 


merely  to  a  layer  of  peritoneum.     A  few  red  vessels  ramified  over 

the  surface  of  the  vesicle,  which  was 
filled  with  a  transparent,  colourless, 
albuminous  fluid,  holding  in  suspen- 
sion minute  whitish  flakes  and  shreds. 
The  lining  membrane  of  the  vesicle 
was  smooth,  transparent,  and  vascu- 
lar, not  at  all  folded  or  discoloured; 
having,  indeed,  every  way  its  usual 
appearance. 

The  ovary  had  besides  upon  its  sur- 
face five  small  yellowish  or  red  spots, 
each  of  which  corresponded  to  a  flat- 
tened reddish  body,  situated  imme- 

„         ^        .  ,  ,  diately  beneath,  precisely  like  those 

Uvary  of  aniinimpregnated  cow;  show-      _  "^  ^  '' 

ing  a  prominent  Graafian  vesicle.  m  the  Other  OVary. 


OBSERVATION   XXIII, 


Corpus  luteum  of  a  cow  about  three  and  a  half  months  pregoant. 

This  cow  was  slaughtered  Dec.  7th,  1850.  One  of  the  uterine  cor- 
nua  contained  a  foetus  weighing  a  pound  and  a  half.  The  eyelids  of 
the  foetus  were  agglutinated.  The  skin  was  perfectly  naked,  and 
covered  with  a  fine  vascular  network. 

The  ovary  corresponding  to  that  horn  of  the  uterus  which  con- 
tained the  foetus,  presented  on  one  of  its  lateral  surfaces  a  yellowish 
projection,  similar  to  that  described  in  Observation  XXII.,  only  not 
quite  so  prominent.  Its  summit  had  the  same  softish,  velvety  ap- 
pearance, Avith  a  central  radiated  white  line.  The  substance  of  the 
corpus  luteum,  however,  felt  through  the  ovarian  walls,  was  not  so 
firm  and  resisting  as  in  the  preceding  case,  but  softish,  and  even 
gave  to  the  fingers  an  indistinct  sense  of  fluctuation.  On  making  a 
longitudinal  incision,  the  corpus  luteum  was  found  to  be  very  large, 
measuring  five-eighths  of  an  inch  in  depth.  It  was  solid  like 
the.  others,  and  had  a  very  evident  white,  radiated,  central  cicatrix. 
Its  substance  was  of  a  rich,  soft,  pulpy  consistency,  and  its  colour 
was  a  deep  orange  yellow,  very  distinguishable  from  the  pale  stone- 


OBSERVATIONS     OS    ANIMALS.  89 

yellow  of  the  preceding  observation.  Its  relations  to  the  investing 
membrane,  &c.  were  the  same  as  in  previous  cases.  (Plate  IV.,  Fig.  2.) 

Beside  this  body,  the  ovaries  contained  five  obsolete  bodies  of  a 
brick-red  colour  and  three  of  a  dingy  yellow,  the  situation  of  which 
was  marked  by  similar  spots  on  the  surface.  The  structure  of  these 
obsolete  bodies  was  the  same  as  has  been  already  described  in  pre- 
vious cases. 

There  were  no  projecting  Graafian  vesicles  in  either  ovary,  but  an 
abundance  of  them,  of  moderate  size,  buried  beneath  the  albugineous 
tunic. 


OBSERVATION    XXIV. 

Corpora  lutea  of  cows,  from  five  to  six  and  a  half  montlis  pregnant. 

On  the  20th  of  Dec.  1850,  I  obtained  the  uterine  organs  of  three 
cows  which  had  been  slaughtered  Avithin  a  day  or  two. 

The  first  uterus  contained  a  well  formed  foetus  that  weighed  a 
little  over  five  pounds.  The  ovary  corresponding  to  the  uterine 
horn  which  enclosed  the  foetus,  contained  a  corpus  luteum,  ovoid 
in  shape,  of  a  softish,  rich,  pulpy  consistency,  and  a  deep  orange- 
yellow  colour,  and  measuring  seven-eighths  of  an  inch  in  length,  by 
five-eighths  in  depth.  Its  section  showed  plenty  of  vessels  in  the 
interstices  of  the  convolutions.  There  was  also  some  vascularity  ex- 
ternally, on  the  sides  of  the  tumour. 

The  ovaries  contained  also  three  obsolete  corpora  lutea  of  a  brick- 
red  colour,  the  largest  of  which  was  one-eighth  of  an  inch  in  depth. 

There  were  also  several  Graafian  vesicles,  slightly  prominent,  the 
largest  a  little  over  a  quarter  of  an  inch  in  diameter. 

The  second  uterus  contained  a  foetus  weighing  a  little  less  than 
ten  pounds.  The  ovary,  corresponding  to  the  pregnant  horn  of  the 
uteru",  contained  a  corpus  luteum  of  an  ovoid  shape,  rather  over 
seven-eighths  of  an  inch  in  length  by  three-quarters  in  depth.  It 
was  soft  and  pulpy,  and  of  a  very  strong  orange-yellow  colour. 
There  was  no  vascularity  externally. 

The  ovary  contained  also  three  obsolete  bodies,  very  small  and  of 
a  red  colour,  and  several  Graafian  vesicles,  one  of  which  was  slightly 
prominent  but  the  others  nearly  or   quite   concealed  beneath  the 
ovarian  integuments. 
7 


90 


PRIZE    ESSAY. 


The  other  ovary  was  in  an  extremely  inactive  condition,  though 
natural  in  structure.  It  presented  absolutely  no  obsolete  corpora 
lutea,  and  no  Graafian  vesicles  at  all  prominent. 

The  third  uterus  contained  a  foetus  weighing  fifteen  pounds.  The 
ovary  corresponding  to  the  pregnant  horn  presented  a  soft  and  pulpy 
corpus  luteum,  measuring  one  inch  in  its  long,  and  fifteen-sixteenths 
of  an  inch  in  its  short  diameter,  and  of  a  deep  orange-yellow  colour. 
There  was  no  vascularity  externally.  The  ovaries  contained,  beside, 
only  two  obsolete  red  bodies.  There  were  no  prominent  Graafian 
vesicles,  and  only  a  few  small  ones  superficially  situated. 


Fig.  20. 


OBSERVATION   XXV. 

Corpus  luteum  of  a  cow  about  six  and  a  half  months  pregnant. 

The  cow  was  killed  on  the  12th  of  December,  1850.     The  uterus 

contained  a  foetus  weighing  sixteen 
pounds.  The  eyelids  were  still  ag- 
glutinated, but  could  be  separated 
by  gentle  traction.  Hair  was  just 
beginning  to  show  itself  on  the  fore- 
head, but  the  remainder  of  the  skin 
was  quite  naked. 

The  ovary  corresponding  to  the 
pregnant  horn  of  the  uterus  was 
one  inch  and  five-eighths  in  length. 
One  end  of  it  was  occupied  by  a 
yellowish  tumour,  on  the  summit  of 
which  was  a  nearly  circular  spot 
where  the  fibrous  tunic  was  wanting, 
and  the  yellow  colour  consequently 
more  distinct.  The  tumour  was  of 
a  rounded  form  and  a  softish  con- 
sistency. Its  sides  were  pretty 
abundantly  covered  with  red  and 
purple  vessels. 

The  section  of  this  corpus  luteum  was  solid,  but  its  central  cicatrix 
was  still  easily  recognizable.  The  body  was  of  an  ovoid  shape  and 
measured  one  inch  and  one-eighth  in  its  long  diameter.     Its  sub- 


Corpus  luteum  of  a  cow  about  six  and  a 
half  months  pregnant. 


OBSERVATIONS    ON    ANIMALS.  91 

stance  was  of  a  strong  orange  colour,  and  presented  in  a  high  degree 
the  soft,  rich,  pulpy  aspect,  already  observed  as  belonging  to  the 
corpora  lutea  of  pregnant  cows.  The  structure  of  the  body  was  the 
same  as  in  the  preceding  cases. 

The  ovaries  contained  also  one  obsolete  corpus  luteum  of  a  red 
colour,  and  five  others  of  a  yellowish  tinge ;  but  the  latter  were  all 
exceedingly  small  and  very  faint.  Nearly  all  the  Graafian  vesicles 
were  situated  entirely  underneath  the  albugineous  tunic.  None 
observed  prominent. 


OBSERVATION   XXVI. 

Corpus  luteum  of  a  cow  eight  months  pregnant. 

A  COW,  belonging  to  Mr.  Potter,  of  Cambridge,  was  found  to  be 
sick  on  the  morning  of  Friday,  November  29th,  1850.  She  had 
been  covered  by  the  bull  in  the  early  part  of  April  in  the  same  year, 
and  had  been  with  young  ever  since.  The  animal  appeared  dull, 
seemed  to  sufi'er  from  pain  internally,  and  had  some  coolness  of  the 
ears  and  horns.  She  rapidly  grew  worse,  and  on  Sunday  there  was 
much  vomiting  and  swelling  of  the  abdomen.  She  died  on  the  after- 
noon of  Sunday,  having  a  short  time  before  expelled  a  calf  that 
weighed  thirty-three  pounds. 

At  the  examination  of  the  body,  on  the  same  day,  there  was  found 
very  extensive  peritonitis  which  appeared  to  radiate  from  a  spot  on 
the  surface  of  the  "paunch,"  or  first  stomach,  corresponding  in  situa- 
tion to  a  similar  spot  of  ecchymosis  in  the  thickness  of  the  abdominal 
parietes.  The  animal  had  apparently  received  a  blow  in  the  abdo 
men  which  gave  rise  to  peritoneal  inflammation. 

The  left  horn  of  the  uterus,  moderately  contracted,  still  contained 
the  greater  part  of  the  membranes  belonging  to  the  foetus  which  had 
been  expelled.  The  right  horn  contained  a  second  foetus,  dead,  but 
quite  fresh  looking,  and  well  developed.  Its  weight  was  forty-two 
and  a  half  pounds. 

The  left  ovary  was  one  and  a  half  inches  in  length.  It  had  no 
well  marked  cicatrices  on  its  surface,  but  showed  at  one  extremity 
a  slightly  prominent  Graafian  vesicle,  three-sixteenths  of  an  inch  in 
diameter.  There  were  also  numerous  others,  much  smaller,  on  the 
lateral  surfaces  of  the  organ.     On  the  free  edge  of  the  ovary  there 


92  PRIZE     ESSAY. 

was  an  abrupt  prominence,  a  quarter  of  an  incli  in  height  and  three- 
eighths  in  length,  of  a  faint  orange-yellow  colour.  The  peritoneum 
was  continuous  over  the  whole  of  the  tumour,  and  on  its  summit 
there  was  a  faint,  whitish,  radiated  cicatrix.  The  base  of  the 
tumour  was  somewhat  constricted,  and  just  at  the  line  of  constric- 
tion, there  existed  some  purplish  vascularity. 

On  makinor  a  longitudinal  section  of  the 
''■  "  ■  ovary,  through  the  remains  of  the  cicatrix, 

the  whole  corpus  luteum  was  exposed,  and 
the  external  projection  was  seen  to  form 
only  a  small  part  of  the  entire  body.  It 
measured  nine-sixteenths  of  an  inch  in  its 
long,  and  three-eighths  of  an  inch  in  its 
short  diameter.  It  consisted  of  a  tolerably 
firm,  solid  mass,  of  an  ovoid  shape,  and  of 
an  exceedingly  rich  orange-yellow  colour, 
which  was  uniform  throughout.  There 
was  no  cavity  anywhere,  but  about  the 
^^         ^  ,_         .u    edges  of  the   section  might  be  seen  the 

Ovary  of  a  cow,  eight  months         o  _  o       _ 

pregnant ;  showing  the  promi-  marks  of  previous  Compression  and  fold- 
nent  portion  of  a  corpus  lu-  j^j    .  .^^^  ^  ^^[^^^  narrow,  nearly  straight 

teum.  PI  •        • 

line  ran  irom  the  most  projecting  part,  a 
considerable  distance  into  the  interior  of  the  body.  The  projecting 
part  appeared  to  have  been  folded  doAvn  toward  the  lower  extremity 
of  the  ovary,  and  confined  in  that  position  by  the  contraction  of 
the  investing  membranes.  (PI.  IV.,  Fig.  3.) 

The  substance  of  the  corpus  luteum  was  of  a  highly  organized 
appearance.  No  vessels,  however,  were  to  be  seen  in  it,  except 
where  they  ramified  in  the  furrows  about  its  edge.  Its  relations 
to  the  surrounding  tissues  were  the  same  as  in  preceding  cases. 

The  right  ovary  was  one  and  three-quarter  inches  in  length.  Its 
surface  was  like  that  of  the  other,  showing  one  Graafian  vesicle, 
about  one-fourth  or  three-sixteenths  of  an  inch  m  diameter,  and 
many  other  smaller  ones.  On  the  free  edge  of  the  organ  was  an 
orange-yellow  spot  like  that  on  the  left,  only  not  projecting.  The 
corpus  luteum  which  was  situated  beneath  was  entirely  similar  to 
that  in  the  left  ovary,  except  in  being  somewhat  larger,  and  in 
having  near  its  centre  a  small,  narrow,  white,  radiated  cicatrix, 
from  which  a  faint  whitish  line  ran  to  the  external  surface  of  the 
corpus  luteum,  on  the  free  edge  of  the  ovary.    (Fig.  22.) 

There  were  no  other  marks  or  spots  observed  on  the  surface  of 
the  ovaries  indicating  corpora  lutea. 


OBSERVATIONS    ON    ANIMALS. 


93 


Ovary  of  a  cow  eight  months  pregnant. 


It  is  evident,  from  the  foregoing  Fig.  22. 

observations,  that  the  formation  of 
the  corpus  luteum  in  the  cow  is  very 
similar  to  that  whicli  takes  place  in 
the  human  female  ;  the  diiference 
between  the  two  consisting  only  in 
details,  while  the  general  plan  re- 
mains the"  same.  There  is  in  the  first 
place,  no  yellow  matter  deposited,  as 
some  writers  have  maintained,  pre- 
vious to  the  rupture  of  the  vesicle  ; 
but,  at  the  time  when  this  occur- 
rence takes  place,  the  walls  of  the 
vesicle  are  smooth  and  membranousj 
presenting  indeed  altogether  their 
usual  appearance. 

Soon  afterward,  however,  a  growth 
takes  place  from  the  inner  surface  of  the  cavity,  and  assumes  the 
same  convoluted  form  as  in  the  human  species.  In  the  cow,  however, 
this  new  growth  is  much  more  rapid  and  abundant.  It  soon  com- 
pletely fills  and  distends  the  cavity  of  the  vesicle,  and  even  sprouts 
luxuriantly  from  its  aperture,  in  the  manner  of  a  fungous  growth ; 
forming  a  very  noticeable  protuberance  on  the  surface  of  the  ovary. 
The  peritoneum  is  soon  reproduced  over  this  protuberance,  and  the 
sides  of  the  tumour  are  covered  with  vascularity.  The  substance  of 
the  corpus  luteum,  which  was  at  first  of  a  pale  undefined  hue,  like 
recent  lymph,  has  now  acc[uired  a  strong  yellow  colour,  and  presents 
a  solid  mass  of  an  ovoid  shape,  with  its  centre  occupied  by  a  pale, 
radiated  cicatrix,  the  result  of  the  closino-  tofrether  of  the  vesicular 
parietes. 

The  corpus  luteum  seems  to  attain  this  condition  in  about  two 
weeks  after  the  discharge  of  the  ovum.  After  that  period  it  follows 
a  retrograde  course,  which  is  characterized  by  the  following  changes. 
The  central  cicatrix  becomes  more  and  more  indistinct.  The  yellow 
matter  changes  its  colour  to  a  dull  yellowish-brown,  and  afterward 
most  commonly  to  a  brick  red ;  though  there  is  reason  to  believe 
that  the  latter  alteration  does  not  invariably  take  place.  At  the 
same  time  it  contracts  a  more  intimate  adhesion  with  the  neighbour- 
ing parts,  and  its  investing  membrane  becomes  confounded  with  the 
adjacent  areolar  tissue;  so  that  at  last  it  appears  as  a  mere  spot,  or 
islet,  in  the  ovarian  substance,  presenting  to  the  eye  a  reticulated 
appearance,  and  incapable  of  being  separated  from  the  ovary  as  an 


94  PRIZE    ESSAY. 

entire  body.  There  are  usually  several  of  these  obsolete  bodies,  of 
different  sizes,  to  be  seen  in  the  ovaries  together,  provided  the  ani- 
mal is  not  pregnant ;  their  situations  being  indicated  by  small  red 
spots  on  the  surface  of  the  ovary. 

The  difference  in  aspect  between  the  corpus  luteum  following  an 
ordinary  ovulation,  and  that  which  accompanies  pregnancy  is  not  so 
striking  in  the  cow  as  in  the  human  female.  This  is  apparently 
owing  to  two  circumstances;  first,  that  in  the  cow  there  "is,  at  the 
time  of  the  rupture  of  a  vesicle,  but  little  or  no  hemorrhage  into  its 
cavity  ;  and  secondly,  that  the  groAvth  of  yellow  matter  which  takes 
place  afterward,  is  so  much  more  rapid  and  abundant.  It  will  be 
recollected  that  one  of  the  most  important  distinctions  between  the 
human  corpus  luteum  of  menstruation  and  that  of  pregnancy  was 
the  thickness  of  its  yellow  wall,  as  compared  with  the  central 
coagulum;  and  since  in  the  cow  there  is  little  or  no  central  coagu- 
lum,  and  since  the  yellow  wall  always  becomes  thick  enough  to  fill 
the  cavity  of  the  vesicle,  the  above  distinction  cannot  be  here 
applied.  Nevertheless,  there  is  another  equally  important  distinc- 
tion which  still  remains  applicable,  viz.,  the  longer  duration  of  the 
corpus  luteum,  when  its  growth  is  modified  by  the  occurrence  of 
pregnancy.  It  has  been  demonstrated  (Obs.  XVI.)  that,  at  the  time 
of  the  rupture  of  a  vesicle,  the  corpus  luteum  of  the  preceding  ovu- 
lation has  already  become  distinctly  retrograde ;  its  colour  conside- 
rably lighter,  and  its  size  reduced.  Before  the  new  vesicle  has  as- 
sumed entirely  the  appearance  of  a  corpus  luteum,  the  old  yellow 
body  (Plate  III.,  Fig.  2,  a)  has  become  still  farther  atrophied  ;  its 
cavity  entirely  obliterated,  its  central  cicatrix  indistinct,  and  the 
whole  body  reduced  to  not  more  than  a  quarter  part  the  size  which 
it  had  at  the  period  of  its  greatest  development.  (Plate  III.,  Fig.  4.) 
It  appears,  therefore,  to  be  sufficiently  well  ascertained  that,  in  this 
animal,  the  corpus  luteum  ordinarily  reaches  its  maximum  of  deve- 
lopment in  about  two  weeks  after  the  rupture  of  the  vesicle,  and 
that  a  period  of  three  Aveeks  longer  reduces  it  to  the  condition  of  a 
small,  obsolete,  yellowish  or  brick-red  spot,  without  any  investing 
membrane,  and  not  presenting  any  of  the  ordinary  characteristic 
appearances  of  a  corpus  luteum. 

On  the  other  hand  it  is  certain,  that  if  the  rupture  of  a  Graafian 
vesicle  is  followed  by  pregnancy,  the  corpus  luteum  does  not  attain 
its  greatest  size  till  about  the  middle  of  the  seventh  month  (Obs. 
XXIV.  and  XXV.);  and  that  at  the  termination  of  the  eighth  month 
(Obs.  XXVI.)  it  is  still  of  large  size,  and  sometimes  forms  a  very 
remarkable  prominence  on  the  surface  of  the  ovary.     At  the  same 


OBSERVATIONS    ON    ANIMALS.  95 

time,  the  obsolete  bodies  which  mark  the  situations  of  still  older 
ruptures  gradually  disappear  from  the  ovary;  so  that,  toward  the 
latter  periods  of  gestation,  the  corpus  luteum  of  the  last  rupture  is 
the  only  body  of  the  kind  to  be  found  in  the  organ.  In  those  cases, 
however,  in  Avliich  impregnation  has  not  taken  place,  it  is  not  at  all 
unfrequent  to  find  beside  the  principal  body,  six,  seven,  or  eight 
others,  in  different  stages  of  retrogression. 

The  substance  of  the  corpus  luteum  of  pregnancy,  also,  is  always 
of  a  soft,  rich,  pulpy  consistency,  and  its  colour  a  very  deep  orange- 
yellow;  while  in  the  unimpregnated  animal  its  texture  is  firmer,  and 
it  presents  an  orange  tinge  only  for  a  very  short  period  of  its  exist- 
ence; the  colour  being,  for  the  most  part,  a  very  light  stone-yellow. 

Numerous  observations  on  sheep  have  demonstrated  the  fact,  that 
a  similar  distinction  exists  in  them  between  the  corpus  luteum  of 
ordinary  ovulation  and  that  of  pregnancy.  The  rupture  of  the 
vesicle  in  this  animal,  as  in  the  cow,  is  unaccompanied  by  any  con- 
siderable hemorrhage,  and  the  new  growth  is  afterward  produced 
with  a  similar  rapidity  and  luxuriance.  Its  colour  is  not  by  any 
means  so  brilliant  as  in  the  cow,  but  is  a  dull  yellowish  white.  After 
the  bodies  become  completely  obsolete  they  present  a  dusky  brownish 
spot,  without  any  tinge  of  red.  In  the  retrograde  corpus  luteum  of  the 
sheep,  there  is  sometimes  to  be  found  a  cavity  containing  a  few  drops 
of  clear  fluid,  and  a  lining  of  transparent  lymph.  This,  however,  is 
only  an  occasional  appearance,  and  seems  to  be  owing,  as  in  the 
human  subject,  to  the  accidental  closure  of  the  mouth  of  the  vesicle, 
before  the  complete  coalescence  of  the  walls  in  its  interior. 

With  these  exceptions,  the  growth  and  atrophy  of  these  bodies 
follow  nearly  the  same  course  as  that  which  has  already  been  de- 
scribed. At  the  time  of  the  rupture  of  a  new  vesicle,  the  old  corpus 
luteum,  of  a  fortnight  or  three  weeks  previous,  has  become  much 
reduced  in  size,  and  considerably  paler  in  hue;  while  the  occurrence 
of  pregnancy  causes  it  to  remain  for  a  long  time  nearly  undiminished 
in  size,  and  unchanged  in  colour. 

The  microscopic  appearances  of  the  corpus  luteum  are  nearly  the 
same  in  the  cow  and  sheep;  the  only  difference  consisting  in  the 
amount  of  oil  present,  which  is  quite  abundant  in  the  former,  and 
rather  scanty  in  the  latter;  at  least,  until  a  late  period  of  its  develop- 
ment. There  are  to  be  seen,  in  the  substance  of  the  convoluted 
wall,  an  abundance  of  pale,  roundish,  or  irregularly  elongated  cells, 
faintly  granulated,  sometimes  containing  minute  drops  of  oil,  and 
often,  particularly  in  the  early  periods,  circular  or  oval  nuclei,  with 
nucleoli. 


96 


PRIZE     ESSAY 


Fis.23. 


Cells  from  a  corpus  luteum  of  ihe  cow, 
at  its  maximum  of  development.  (Obs. 
21st.)  Each  division  of  the  scale  is 
about  .0004  of  an  inch. 


Cells  from  the  corpus  luteum  of  a  cow, 

six  months  pregnant.  (Obs.  24.) 
Same  scale. 


The  nuclei  may  sometimes  be  seen  floating  about  the  field,  unpro- 
vided with  any  cell-membrane.  While  the  corpus  luteum  is  in  its 
early  stages,  there  is  also  a  large  quantity  of  the  spindle-shaped 
cells  of  areolar  tissue  in  process  of  development,  to  be  seen  in  inti- 
mate connexion  Avith  the  other  elements. 

As  the  corpus  luteum  grows  older,  the  spindle-shaped  cells  are 
less  numerous,  and  the  oil,  which  is  evidently  secreted  by  the  larger 
cells,  becomes  more  and  more  abundant,  as  the  latter  are  atrophied 
and  disappear.  Finally,  the  whole  field  is  occupied  by  globules  of 
oil,  of  various  sizes,  Avhile  the  cells  are  too  few,  or  too  indistinct  to 
attract  the  notice  of  the  observer. 


FiK.  25. 


Fig.  26. 


Cells  from  the  corpus  luteum  of  an  unim- 
pregnated  ewe,  in  an  early  stage  of  its 
development.     Same  scale. 


Cells  from  the  corpus  luteum  of  an  unim- 
pregnated  ewe,  which  was  commencing 
to  become  retrograde.     Same  scale. 


APPEND  IX. 


Since  the  foregoing  essay  was  written,  and  delivered  to  the  Com- 
mittee, I  have  met  with  the  two  following  passages  relative  to  the 
corpus  luteum,  which  contain  the  same  or  similar  views  with  those 
expressed  in  the  present  memoir.  The  first  extract  is  from  a  work 
by  Drs.  Kirkes  and  Baly,  published  in  London,  in  1848,  and  entitled 
a  '■^Supplement  to  the  SecoJid  Volume  of  3Iiiller's  Physiology.''  I  am 
indebted  to  Prof.  0.  W.  Holmes  for  calling  my  attention  to  the  pas- 
sage in  question.     It  is  as  follows  : — (page  55.) 

"  In  the  figures  given  by  Sir  E.  Home  and  M.  Bischofi"  of  corpora 
lutea  formed  under  these  circumstances  (without  impregnation),  it  is 
evident  that  the  growth  of  the  yellow  substance  has  proceeded  to 
such  an  extent  as  to  protrude  from  the  orifices  of  the  ruptured  folli- 
cles, after  filling  their  cavities.  These  are  certainly  corpora  lutea 
which  could  not  be  distinguished  from  corresponding  bodies  of  the 
same  stage  of  development  in  the  ovaries  of  impregnated  animals. 
In  the  impregnated  animal,  however,  the  corpus  luteum  continues  to 
increase  in  size  after  the  orifice  in  the  follicle  has  closed ;  and 
whether  this  is  the  case  in  animals  which  are  not  impregnated  is 
doubtful.  It  is  probable  that  if  the  ova  have  not  been  fecundated, 
the  state  of  orgasm  of  the  ovaries  and  Graafian  follicles,  which  arose 
during  the  condition  of  heat,  subsides,  and  that  the  corpora  lutea 
then,  instead  of  continuing  to  grow,  quickly  shrivel  and  disappear." 

"  With  regard  to  the  human  female,"  the  author  proceeds  to  re- 
mark, "  the  limitations  with  Avhich  the  rule  may  be  admitted  are 
greater,"  and,  although  he  recognizes  the  fact  that  corpora  lutea 
formed  in  consequence  of  menstruation  are,  generally,  smaller  than 
those  following  pregnancy,  no  other  distinction  between  them  is 
mentioned,  than  their  difi"erence  in  size.  Even  this  is  not  considered 
as  altogether  reliable,  and  the  author  comes  accordingly,  to  the  fol- 
lowing conclusion.  "  If,  in  addition  to  the  foregoing  facts  and  con- 
siderations, the  varieties  in  size  of  the  corpora  lutea  formed  during 
pregnancy  are  borne  in  mind,  it  will  be  seen  that  cases  can  seldom 
occur  where  the  mere  presence  of  one  of  these  bodies  can  be  taken 


98  APPENDIX. 

as  a  proof  of  previous  impregnation,"  (p,  56.)  'The  writer,  therefore, 
does  not  admit  entirely  the  difference  of  development  in  the  human 
corpora  lutea  of  menstruation  and  pregnancy  as  forming  a  distinction 
between  them  ;  and  he  only  considers  it  as  "  probable"  that  such  a 
distinction  exists  in  animals. 

The  second  extract,  however,  contains  expressions  more  definite 
and  satisfactory.  It  is  from  Lonc/et's  Physiology,  Paris,  1850,  vol. 
ii.  p.  88,  De  la  Gdndration. 

"At  the  same  time,"  says  Longet,  "we  must  distinguish  Uoo 
kinds  of  corpora  lutea  ;  those  which  result  from  the  cicatrization  of 
a  follicle,  after  the  spontaneous  expulsion  of  an  ovum,  without  any 
subsequent  conception  ;  and  those  which  are  produced  by  the  same 
processes,  after  the  expulsion  of  an  ovum  followed  by  conception  and 
especially  by  gestation.  Those  belonging  to  the  first  class  rapidly 
pass  through  their  different  stages,  never  attain  a  high  degree  of 
development,  are  much  inferior  to  the  others  in  size,  rapidly  assume 
the  yellow  coloration,  fade  again  in  a  few  days,  and  in  the  course 
of  one  or  two  months  became  retracted  and  completely  concealed  in 
the  ovarian  tissue.  The  second  species  of  corpora  lutea,  participat- 
ing in  the  congestion  and  functional  activity,  which  are  established 
in  all  the  sexual  organs  during  gestation,  attain  a  size  sometimes 
greater  than  that  of  the  ovary  itself,  and  pass  so  slowly  through  the 
different  stages  of  their  development  and  atrophy,  that  they  are 
still  perceptible  at  the  termination  of  pregnancy ;  they  gradually 
diminish  in  size,  in  proportion  to  the  growth  of  the  foetus,  and  the 
approach  of  the  end  of  gestation." 

The  above  statements,  by  Longet,  it  will  be  seen  correspond  en- 
tirely with  those  brought  forward  in  the  present  essay.  They  are 
given  by  him,  however,  altogether  under  the  form  of  general  deduc- 
tions ;  and  the  reader  is  not  supplied  with  any  series  of  observations 
which  would  convince  him  of  their  reliability.  It  is  in  the  foregoing 
pages  alone,  so  far  as  I  am  aware,  that  the  difference  of  the  two 
species  of  corpora  lutea  has  been  absolutely  demonstrated ;  so  that 
the  distinction  between  them  no  longer  rests  on  bare  assertion,  but 
on  the  evidence  of  recorded  facts. 

J.  C.  D. 


EXPLANATION  OF  THE  PLATES. 


N.  B. — All  the  drawings  were  taken  from  nature,  and  arc  of  the 
natural  size. 

The  figures  in  the  first  two  plates  are  all  taken  from  the  human 
subject. 


PLATE   I. 

Fig.  1.  Graafian  vesicle,  recently  ruptured  and  filled  with  blood.     (Obs.  1.) 

Fig.  2.  Ovary  of  a  girl  three  weeks  after  menstruation ;  showing  the  promi- 
nence and  vascularity  over  the  corpus  luteum.     (Obs.  6.) 

Fig.  3.  The  same  ovary  cut  open;  showing  the  corpus  luteum  of  menstruation 
three  weeks  old. 

Fig.  4.  Corpus  luteum  of  menstruation  four  weeks  old.     (Obs.  9.) 

Fig.  5.  Corpus  luteum  of  menstruation  thirty  days  old.     (Obs.  10.) 

PLATE  II. 

Fig.  1.  Corpus  luteum  of  menstruation  nine  weeks  old.  (Obs.  IL) 

Fig.  2.  Corpus  luteum   of  pregnancy  about  the  end  of  the    second   month. 
(Obs.  12.) 

Fig.  3.  Corpus  luteum  of  pregnancy  about  the  termination  of  the  fourth  month. 
(Obs.  13.) 

Fig.  4.  Ovary  of  a  woman  seven  months  pregnant;  showing  the  prominence  of 
the  corpus  luteum.     (Obs.  14.) 

Fig.  5.  The  same  ovary  cut  open. 

PLATE   III. 

Fig.  1.  Ovary  of  an  unimpregnated  cow.     (Obs.  20.) 
a.  Old  corpus  luteum  seen  externally. 
h.  New  corpus  luteum  seen  externally. 

Fig.  2.  The  same  ovary  cut  open. 

a.  Old  corpus  luteum. 

b.  Ruptured  Graafian  vesicle  in  process  of  transformation  into  a 

corpus  luteum. 


100  EXPLANATION    OF    THE    PLATES. 

Fig.  3.  Corpus  luteiim  of  the  unimpregnated  cow  at  its  maximum  of  develop- 
ment.    External  vie\Y.     (Obs.  21.) 

Fig.  4.  Same  as  the  above.     Internal  vievr. 

Fig.  5.  Corpus  luteum  of  the  unimpregnated  cow  beginning  to  retrograde. 
External  view.     (Obs.  22.) 

PLATE   IV. 
Fig.  1.  Same  as  the  above.     Internal  view. 

Fig.  2.  Corpus  luteum  of  a  cow  about  three  and  a  half  months  pregnant. 
(Obs.  23.) 

Fig.  3.  Corpus  luteum  of  a  cow  eight  months  pregnant.     (Obs.  26.) 

Fig.  4.  Corpus  luteum  of  the  unimpregnated  ewe  at  its  maximum  of  develop- 
ment. 

a.  External  view.  ) 

b.  Internal  view. 

Fig.  5.  a.  Ovary  of  an  unimpregnated  ewe  ;  showing  the  aperture  of  a  recently- 
ruptured  Graafian  vesicle,  and  the  prominence  of  the  last  corpus 
luteum. 

b.  The  same  ovary  cut  open ;  showing  the  last  corpus  luteum. 

Fig.  6.  a.  Ovary  of  a  ewe,  the  uterus  of  which  contained  a  foetus  eight  and  a 
half  inches  in  length. 

b.  The  same  ovary  cut  open. 


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